Provider Demographics
NPI:1427153055
Name:ESPARZA, RICARDO (PHD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:ESPARZA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2086
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80522-2086
Mailing Address - Country:US
Mailing Address - Phone:303-444-3443
Mailing Address - Fax:970-221-3730
Practice Address - Street 1:777 29TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2358
Practice Address - Country:US
Practice Address - Phone:303-447-0022
Practice Address - Fax:303-541-9712
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO646103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO92386Medicare ID - Type Unspecified
R21014Medicare UPIN