Healthcare Provider Details

I. General information

NPI: 1780925495
Provider Name (Legal Business Name): ELENA M ESPARZA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N RECORD AVE
LOS ANGELES CA
90063
US

IV. Provider business mailing address

303 N RECORD AVE
LOS ANGELES CA
90063
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-2144
  • Fax: 323-544-1442
Mailing address:
  • Phone: 323-268-2144
  • Fax: 323-544-1442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number26717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: