Provider Demographics
NPI:1669184529
Name:ESPINOSA, ACE DERICK
Entity type:Individual
Prefix:
First Name:ACE
Middle Name:DERICK
Last Name:ESPINOSA
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 1:455 S 700 E UNIT 4321
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3886
Mailing Address - Country:US
Mailing Address - Phone:862-505-9651
Mailing Address - Fax:
Practice Address - Street 1:455 S 700 E UNIT 4321
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-3886
Practice Address - Country:US
Practice Address - Phone:862-505-9651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician