MEDICARE: RENALDO L ESPINOSA DE LOS MONTEROS PA

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	363A00000X	Physician Assistant	PA 10456	CA

General Provider Information

NPI Number	:	1316148885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENALDO L ESPINOSA DE LOS MONTEROS PA

Provider Business Mailing Address
First Line	:	11725 GARVEY AVE
Second Line	:	SUITE 5B
City	:	EL MONTE
State	:	CA
Zip	:	91732-4534
Country	:	US
Telephone Number	:	626-579-0707
Fax Number	:	626-579-0235

Provider Business Practice Location Address
First Line	:	11725 GARVEY AVE
Second Line	:	SUITE 5B
City	:	EL MONTE
State	:	CA
Zip	:	91732-4534
Country	:	US
Telephone Number	:	626-579-0707
Fax Number	:	626-579-0235

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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