Provider Demographics
NPI:1477307866
Name:ESPINOZA, STEPHANIE EMILY
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:EMILY
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 DESERT SENNA AVE SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-5024
Mailing Address - Country:US
Mailing Address - Phone:505-495-7015
Mailing Address - Fax:
Practice Address - Street 1:740 DESERT SENNA AVE SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-5024
Practice Address - Country:US
Practice Address - Phone:505-495-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician