Healthcare Provider Details

I. General information

NPI: 1831973478
Provider Name (Legal Business Name): ELSA MICHELLE ESPARZA MPH, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 BERKELEY WAY
BERKELEY CA
94720-2502
US

IV. Provider business mailing address

1207 MELVILLE SQ APT 214
RICHMOND CA
94804-4566
US

V. Phone/Fax

Practice location:
  • Phone: 909-477-0253
  • Fax:
Mailing address:
  • Phone: 909-477-0253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86116067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: