Healthcare Provider Details

I. General information

NPI: 1265610026
Provider Name (Legal Business Name): EVELYN ESPINOZA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVELYN ESPINOZA RN

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S COMMONWEALTH AVE STE 800
LOS ANGELES CA
90005-4018
US

IV. Provider business mailing address

1940 MILL RD APT A
SOUTH PASADENA CA
91030-2259
US

V. Phone/Fax

Practice location:
  • Phone: 213-448-8984
  • Fax:
Mailing address:
  • Phone: 213-448-8984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number611272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: