Healthcare Provider Details

I. General information

NPI: 1679898308
Provider Name (Legal Business Name): OVET ESPARZA PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JOSE FIGUERES AVE STE 490
SAN JOSE CA
95116-1595
US

IV. Provider business mailing address

1470 LAUREL ST APT 1
SAN CARLOS CA
94070-5120
US

V. Phone/Fax

Practice location:
  • Phone: 408-272-2252
  • Fax:
Mailing address:
  • Phone: 928-271-9508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 20860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: