Provider Demographics
NPI:1255492856
Name:ESPINOSA, BRYAN V (PA)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:V
Last Name:ESPINOSA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1683 WINDSHIP CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-7559
Mailing Address - Country:US
Mailing Address - Phone:702-287-8004
Mailing Address - Fax:
Practice Address - Street 1:4845 S RAINBOW BLVD STE 401
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4750
Practice Address - Country:US
Practice Address - Phone:702-644-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV453363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical