Healthcare Provider Details

I. General information

NPI: 1417758392
Provider Name (Legal Business Name): ESSI CA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4772 KATELLA AVE STE 200
LOS ALAMITOS CA
90720-2683
US

IV. Provider business mailing address

1110 N VIRGIL AVE PMB 93712
LOS ANGELES CA
90029
US

V. Phone/Fax

Practice location:
  • Phone: 516-584-8710
  • Fax: 516-584-8711
Mailing address:
  • Phone: 516-584-8710
  • Fax: 516-584-8711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JUDY LAWRENCE
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 631-456-2514