Provider Demographics
NPI:1194497735
Name:VALDES ESPINO, MARIO JOSE (NP-C, FNP)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:JOSE
Last Name:VALDES ESPINO
Suffix:
Gender:M
Credentials:NP-C, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S GIBSON RD APT 11101
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-0003
Mailing Address - Country:US
Mailing Address - Phone:702-540-2259
Mailing Address - Fax:
Practice Address - Street 1:111 S GIBSON RD APT 11101
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-0003
Practice Address - Country:US
Practice Address - Phone:702-540-2259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV813487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily