Provider Demographics
NPI:1518985191
Name:ESPINO, GUSTAVO ABEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:ABEL
Last Name:ESPINO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4343 PAN AMERICAN FWY NE STE 236
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6834
Mailing Address - Country:US
Mailing Address - Phone:505-600-2511
Mailing Address - Fax:505-300-4977
Practice Address - Street 1:4343 PAN AMERICAN FWY NE STE 236
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-6834
Practice Address - Country:US
Practice Address - Phone:505-600-2511
Practice Address - Fax:505-300-4977
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM98-49207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ1106Medicaid
NMZ1106Medicaid
NM$$$$$$$$$Medicare PIN