Healthcare Provider Details

I. General information

NPI: 1891628905
Provider Name (Legal Business Name): MARYROSE ESPIL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5713 N PERSHING AVE STE A2
STOCKTON CA
95207-4946
US

IV. Provider business mailing address

5713 N PERSHING AVE STE A2
STOCKTON CA
95207-4946
US

V. Phone/Fax

Practice location:
  • Phone: 209-885-7366
  • Fax:
Mailing address:
  • Phone: 209-885-7366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number546587
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number546587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: