Provider Demographics
NPI:1255500476
Name:ESPINOSA, LAURIE F (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:F
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 W THUNDERBIRD RD STE E580
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4671
Mailing Address - Country:US
Mailing Address - Phone:602-439-0000
Mailing Address - Fax:602-439-0022
Practice Address - Street 1:5750 W THUNDERBIRD RD STE E580
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4671
Practice Address - Country:US
Practice Address - Phone:602-439-0000
Practice Address - Fax:602-439-0022
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3599363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical