1932307147 NPI number — MS. ELLEN ESPINOSA SLP

Table of content: MS. ELLEN ESPINOSA SLP (NPI 1932307147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932307147 NPI number — MS. ELLEN ESPINOSA SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESPINOSA
Provider First Name:
ELLEN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932307147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12708 PIRU BLVD SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87123-3825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-294-3314
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 N 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESTANCIA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-384-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  454 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000Z2752 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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