Healthcare Provider Details

I. General information

NPI: 1609373901
Provider Name (Legal Business Name): ASHLEY MARIE ESPINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1264 RODEO RD
SANTA FE NM
87505-6816
US

IV. Provider business mailing address

1264 RODEO RD
SANTA FE NM
87505-6816
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-2129
  • Fax:
Mailing address:
  • Phone: 505-982-2129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPT00008941
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: