Provider Demographics
NPI:1881405512
Name:ACOSTA ESPINOZA, GABRIEL (LMT)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:ACOSTA ESPINOZA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10854 W ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-5811
Mailing Address - Country:US
Mailing Address - Phone:602-583-3615
Mailing Address - Fax:
Practice Address - Street 1:10854 W ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5811
Practice Address - Country:US
Practice Address - Phone:602-583-3615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-25293225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist