Healthcare Provider Details

I. General information

NPI: 1790956209
Provider Name (Legal Business Name): ESP MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 W ALAMEDA AVE STE 208
BURBANK CA
91505-4800
US

IV. Provider business mailing address

PO BOX 16068
ENCINO CA
91416-6068
US

V. Phone/Fax

Practice location:
  • Phone: 818-558-7075
  • Fax: 818-558-7081
Mailing address:
  • Phone: 818-558-7075
  • Fax: 818-558-7081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4419
License Number StateCA

VIII. Authorized Official

Name: ERIC HANS ESPENSEN
Title or Position: DPM, PRESIDENT
Credential: DPM
Phone: 818-842-7145