Healthcare Provider Details

I. General information

NPI: 1497717391
Provider Name (Legal Business Name): RAYMOND ESPARZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 W COVINA BLVD #203
SAN DIMAS CA
91773-3200
US

IV. Provider business mailing address

1330 W COVINA BLVD #203
SAN DIMAS CA
91773-3200
US

V. Phone/Fax

Practice location:
  • Phone: 909-394-0044
  • Fax: 909-394-6133
Mailing address:
  • Phone: 909-394-0044
  • Fax: 909-394-6133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG77594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: