Healthcare Provider Details

I. General information

NPI: 1003261272
Provider Name (Legal Business Name): LAURA ELVIRA ESPINOSA PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 VAQUERO AVE
LOS ANGELES CA
90032-3008
US

IV. Provider business mailing address

2831 VAQUERO AVE
LOS ANGELES CA
90032-3008
US

V. Phone/Fax

Practice location:
  • Phone: 323-253-9093
  • Fax:
Mailing address:
  • Phone: 323-253-9093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number357077
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number357077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: