Provider Demographics
NPI:1861847337
Name:ESPINOSA, ROSA ELENA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:ELENA
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:ROSA
Other - Middle Name:ELENA
Other - Last Name:ESPINOZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4364 BONITA RD
Mailing Address - Street 2:#233
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVE. LAS PALMAS NO. 5049
Practice Address - Street 2:FRACC. LAS PALMAS
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22106
Practice Address - Country:MX
Practice Address - Phone:01152664-681-1369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ856014122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist