Healthcare Provider Details

I. General information

NPI: 1669227690
Provider Name (Legal Business Name): JOHN ESPLANA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14445 OLIVE VIEW DR
SYLMAR CA
91342-1437
US

IV. Provider business mailing address

3297 PERLITA AVE APT 1
LOS ANGELES CA
90039-2236
US

V. Phone/Fax

Practice location:
  • Phone: 747-210-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95026783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: