Healthcare Provider Details

I. General information

NPI: 1497880579
Provider Name (Legal Business Name): NICOLE ELIZABETH ESPOSITO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 VALPREDA RD
SAN MARCOS CA
92069-2973
US

IV. Provider business mailing address

4815 KENDALL ST
SAN DIEGO CA
92109-2224
US

V. Phone/Fax

Practice location:
  • Phone: 760-736-6700
  • Fax: 760-736-8740
Mailing address:
  • Phone: 619-675-6918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA91107
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA91107
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: