Healthcare Provider Details

I. General information

NPI: 1114263266
Provider Name (Legal Business Name): JOSELYN ILANNA ESPINOZA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 RINCONADA BLVD STE 2A
LAS CRUCES NM
88011-7194
US

IV. Provider business mailing address

2530 ALYSSA DR SW
ALBUQUERQUE NM
87105-4994
US

V. Phone/Fax

Practice location:
  • Phone: 575-382-2054
  • Fax: 575-382-4320
Mailing address:
  • Phone: 240-988-2305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH4090
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: