Healthcare Provider Details

I. General information

NPI: 1902045727
Provider Name (Legal Business Name): MICHELLE S ESPINOLA B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 W MAIN ST
MERCED CA
95340-4718
US

IV. Provider business mailing address

642 W MAIN ST
MERCED CA
95340-4718
US

V. Phone/Fax

Practice location:
  • Phone: 209-205-1058
  • Fax: 209-205-1062
Mailing address:
  • Phone: 209-205-1058
  • Fax: 209-205-1062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: