MEDICARE: VIRGIE ESPIRITU ROY RN BSN

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	163WC0200X	Critical Care Medicine Registered Nurse	693245	NY
2	163WC0200X	Critical Care Medicine Registered Nurse	860810	TX
3	163WC0200X	Critical Care Medicine Registered Nurse	RN9380526	FL
4	163WC0200X	Critical Care Medicine Registered Nurse	RN71814	NM
5	163WC0200X	Critical Care Medicine Registered Nurse	95042997	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y8881922	OTHER	CA	DRIVERS LICENSE

General Provider Information

NPI Number	:	1619632833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGIE ESPIRITU ROY RN BSN

Provider Business Mailing Address
First Line	:	4151 ROWLAND DR
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-9799
Country	:	US
Telephone Number	:	650-861-2938
Fax Number	:

Provider Business Practice Location Address
First Line	:	4151 ROWLAND DR
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-9799
Country	:	US
Telephone Number	:	650-861-2938
Fax Number	:

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

Provider Enumeration Date	:	11/02/2021
Last Update Date	:	11/02/2021

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