Healthcare Provider Details

I. General information

NPI: 1932131638
Provider Name (Legal Business Name): MARCHELLE ETHEL ESPARZA MPT, OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCHELLE ETHEL BOYER MPT, OCS

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 EL CAMINO REAL SUITE 100
TUSTIN CA
92780-3655
US

IV. Provider business mailing address

250 EL CAMINO REAL SUITE 100
TUSTIN CA
92780-3655
US

V. Phone/Fax

Practice location:
  • Phone: 714-838-6999
  • Fax: 714-838-7099
Mailing address:
  • Phone: 714-838-6999
  • Fax: 714-838-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: