Healthcare Provider Details

I. General information

NPI: 1306272059
Provider Name (Legal Business Name): ELIZABETH ESPIN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PEPPER AVE
COLTON CA
92324-1801
US

IV. Provider business mailing address

400 N PEPPER AVE
COLTON CA
92324-1801
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-3144
  • Fax: 909-580-2165
Mailing address:
  • Phone: 909-580-3144
  • Fax: 909-580-2165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number775771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: