=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528670734
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROLANDO ANDRES ESPINO APRN-CNP, PMHNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2020
-----------------------------------------------------
Last Update Date | 08/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 DENVER AVE
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79902-3008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-544-4000
-----------------------------------------------------
Fax | 915-351-6601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4849 N MESA ST STE 201
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79912-5919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-351-6600
-----------------------------------------------------
Fax | 915-351-6601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 902617
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 1010015
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------