Healthcare Provider Details

I. General information

NPI: 1508955170
Provider Name (Legal Business Name): MIGUEL ANGEL ESPIN MEJIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15211 VANOWEN ST STE 206
VAN NUYS CA
91405-3620
US

IV. Provider business mailing address

320 GOLDEN SHR STE 201
LONG BEACH CA
90802-4243
US

V. Phone/Fax

Practice location:
  • Phone: 181-878-7847
  • Fax: 181-878-7867
Mailing address:
  • Phone: 186-620-9107
  • Fax: 156-226-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG42563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: