MEDICARE: MS. LAURA ELVIRA ESPINOSA PNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	357077	CA
2	363LP2300X	Primary Care Nurse Practitioner	357077	CA

General Provider Information

NPI Number	:	1003261272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA ELVIRA ESPINOSA PNP

Provider Business Mailing Address
First Line	:	2831 VAQUERO AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90032-3008
Country	:	US
Telephone Number	:	323-253-9093
Fax Number	:

Provider Business Practice Location Address
First Line	:	2831 VAQUERO AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90032-3008
Country	:	US
Telephone Number	:	323-253-9093
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2016
Last Update Date	:	04/25/2016

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