Healthcare Provider Details

I. General information

NPI: 1184758575
Provider Name (Legal Business Name): SUZANNE MARI ESPALIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 SAN DIMAS ST
BAKERSFIELD CA
93301-1298
US

IV. Provider business mailing address

12100 APRIL ANN AVE
BAKERSFIELD CA
93312-3635
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-3787
  • Fax: 661-327-0164
Mailing address:
  • Phone: 661-327-3784
  • Fax: 661-327-0164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG76171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: