Provider Demographics
NPI:1508002262
Name:ESPINOZA, JAVIER E (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:E
Last Name:ESPINOZA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 WEBDOVER AVENUE, SUITE 600
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762
Mailing Address - Country:US
Mailing Address - Phone:432-552-5656
Mailing Address - Fax:432-552-0992
Practice Address - Street 1:1220 W. UNIVERSITY
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763
Practice Address - Country:US
Practice Address - Phone:432-332-6600
Practice Address - Fax:432-332-8011
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05989363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA05989OtherLICENSE