Healthcare Provider Details

I. General information

NPI: 1437773090
Provider Name (Legal Business Name): JOCELYN NUGROHO ESPARZA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5427 WHITTIER BLVD
LOS ANGELES CA
90022-4101
US

IV. Provider business mailing address

PO BOX 50703
PASADENA CA
91115-0703
US

V. Phone/Fax

Practice location:
  • Phone: 888-499-9303
  • Fax:
Mailing address:
  • Phone: 323-793-3138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPTL1342
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number20A20937
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A20937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: