Healthcare Provider Details

I. General information

NPI: 1831966746
Provider Name (Legal Business Name): LANCE ESPIRITU PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13723 DON JULIAN RD
LA PUENTE CA
91746-2715
US

IV. Provider business mailing address

13723 DON JULIAN RD
LA PUENTE CA
91746-2715
US

V. Phone/Fax

Practice location:
  • Phone: 626-320-3257
  • Fax:
Mailing address:
  • Phone: 626-320-3257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95027065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: