Provider Demographics
NPI:1164621470
Name:ESPINOZA, RUBEN OMAR (MD)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:OMAR
Last Name:ESPINOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S COUNTRY CLUB DR STE 3
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-5162
Mailing Address - Country:US
Mailing Address - Phone:480-827-5500
Mailing Address - Fax:480-827-5575
Practice Address - Street 1:1300 S COUNTRY CLUB DR STE 3
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5162
Practice Address - Country:US
Practice Address - Phone:480-827-5500
Practice Address - Fax:480-827-5575
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37232208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ233048Medicaid