Healthcare Provider Details

I. General information

NPI: 1619841053
Provider Name (Legal Business Name): YSSA MARIE MAGNO ESPESO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 WILSHIRE BLVD
SANTA MONICA CA
90403-2333
US

IV. Provider business mailing address

17910 MALDEN ST
NORTHRIDGE CA
91325-3818
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-5523
  • Fax:
Mailing address:
  • Phone: 747-266-8827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number91416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: