Provider Demographics
NPI:1841608486
Name:ESPINOSA, LUIS JR
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:ESPINOSA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 571703
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89157-1703
Mailing Address - Country:US
Mailing Address - Phone:702-301-1122
Mailing Address - Fax:
Practice Address - Street 1:5236 APPLE VALLEY LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-1402
Practice Address - Country:US
Practice Address - Phone:702-301-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner