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General NPI Number Information
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NPI Number | 1578648523
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Entity Type | Organization
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Legal Business Name | RAYMOND J. ESPARZA MD INC.
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 1330 W COVINA BLVD STE 203
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City | SAN DIMAS
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State | CA
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Zip | 91773-3200
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Country | US
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Telephone | 909-394-0044
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Fax | 909-394-6133
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Provider Business Mailing Address
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Address Line | 1330 W COVINA BLVD STE 203
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City | SAN DIMAS
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State | CA
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Zip | 91773-3200
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Country | US
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Telephone | 909-394-0044
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Fax | 909-394-6133
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Authorized Official
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Title or Position | CEO
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Name | DR. RAYMOND J ESPARZA
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Credential | M.D.
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Telephone | 909-394-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G77594
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License Number State | CA
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