1346088556 NPI number — MRS. KIMBERLY PAIGE ESPARZA DPT

Table of content: MRS. KIMBERLY PAIGE ESPARZA DPT (NPI 1346088556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346088556 NPI number — MRS. KIMBERLY PAIGE ESPARZA DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESPARZA
Provider First Name:
KIMBERLY
Provider Middle Name:
PAIGE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DECOSTA
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
PAIGE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346088556
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 COMPASS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENVIEW
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60026-8001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
54 BATTLEFIELD CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RINGGOLD
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30736-5110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-445-3655
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  15612 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: CP032841T , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)