Healthcare Provider Details

I. General information

NPI: 1619105541
Provider Name (Legal Business Name): DARLENE L ESPINOSA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 N MOUNTAIN AVE STE 110
UPLAND CA
91786-5183
US

IV. Provider business mailing address

440 N MOUNTAIN AVE STE 110
UPLAND CA
91786-5183
US

V. Phone/Fax

Practice location:
  • Phone: 909-870-5200
  • Fax:
Mailing address:
  • Phone: 909-870-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA120539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: