Provider Demographics
NPI:1669466553
Name:ESPINOSA, RENEE DIANE (MD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:DIANE
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 E BELL RD STE 3100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2136
Mailing Address - Country:US
Mailing Address - Phone:602-494-3656
Mailing Address - Fax:602-867-3862
Practice Address - Street 1:3805 E BELL RD
Practice Address - Street 2:SUITE 3100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2105
Practice Address - Country:US
Practice Address - Phone:602-867-8644
Practice Address - Fax:602-795-5698
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32798207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ857485Medicaid
AZAZ0444980OtherBCBS
AZ7877619OtherAETNA
AZ2Z4287OtherHEALTHNET
I01862Medicare UPIN
AZ7877619OtherAETNA