Healthcare Provider Details

I. General information

NPI: 1417235706
Provider Name (Legal Business Name): SANDRA LUZ ESPINOSA NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA LUZ VILLAR-MORENO RN

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UCLA MEDICAL PLZ STE 265
LOS ANGELES CA
90095-8344
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-0867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number19659
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: