Healthcare Provider Details

I. General information

NPI: 1699737924
Provider Name (Legal Business Name): JOE H ESPINOSA III IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 NORMAN SCOTT RD SUITE 1
SAN DIEGO CA
92136-5523
US

IV. Provider business mailing address

4445 SAN JOAQUIN ST
OCEANSIDE CA
92057-6024
US

V. Phone/Fax

Practice location:
  • Phone: 619-556-6592
  • Fax:
Mailing address:
  • Phone: 626-222-3358
  • Fax: 619-556-7962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: