Provider Demographics
NPI:1851031496
Name:ESPINOZA, BALDEMAR
Entity Type:Individual
Prefix:
First Name:BALDEMAR
Middle Name:
Last Name:ESPINOZA
Suffix:
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 1:11204 REDSTONE PEAK PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3313
Mailing Address - Country:US
Mailing Address - Phone:915-873-0354
Mailing Address - Fax:
Practice Address - Street 1:11204 REDSTONE PEAK PL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79934-3313
Practice Address - Country:US
Practice Address - Phone:915-873-0354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program