Healthcare Provider Details

I. General information

NPI: 1720618952
Provider Name (Legal Business Name): MARIE FELYN ESPERANZATE LLACUNA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 E DEL MAR BLVD
PASADENA CA
91107-4375
US

IV. Provider business mailing address

4238 LA RICA AVE UNIT A
BALDWIN PARK CA
91706-3135
US

V. Phone/Fax

Practice location:
  • Phone: 626-356-2585
  • Fax: 626-356-2553
Mailing address:
  • Phone: 626-257-1576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number770828
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: