Provider Demographics
NPI:1851449938
Name:ESPINOSA-MORALES, AIXA DAMARIS (MD)
Entity type:Individual
Prefix:
First Name:AIXA
Middle Name:DAMARIS
Last Name:ESPINOSA-MORALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-4000
Mailing Address - Fax:
Practice Address - Street 1:3125 TRANSVERSE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-8008
Practice Address - Country:US
Practice Address - Phone:419-383-3760
Practice Address - Fax:419-383-2957
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD602561402084N0400X
OH35.0843792084N0400X
IDMC02812084N0400X
ORMD1610972084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0126195Medicaid
OH0126195Medicaid