Healthcare Provider Details

I. General information

NPI: 1831693803
Provider Name (Legal Business Name): SOPHIA DESPINA ESPARZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIA DESPINA CALVILLO MD

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E GRAND AVE
ESCONDIDO CA
92025-4604
US

IV. Provider business mailing address

1001 E GRAND AVE
ESCONDIDO CA
92025-4604
US

V. Phone/Fax

Practice location:
  • Phone: 760-520-8200
  • Fax:
Mailing address:
  • Phone: 760-520-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA166490
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: