Basic Information
Provider Information | |||||||||
NPI: | 1104841618 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ESPINOSA | ||||||||
FirstName: | JULIO | ||||||||
MiddleName: | S | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: | JR. | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1860 PENNSYLVANIA AVE | ||||||||
Address2: | STE 145 NORTHBAY NEONATOLOGY ASSOCIATES INC | ||||||||
City: | FAIRFIELD | ||||||||
State: | CA | ||||||||
PostalCode: | 945333590 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8882700340 | ||||||||
FaxNumber: | 8882700331 | ||||||||
Practice Location | |||||||||
Address1: | 300 HOSPITAL DR | ||||||||
Address2: | SUTTER SOLANO MEDICAL CENTER | ||||||||
City: | VALLEJO | ||||||||
State: | CA | ||||||||
PostalCode: | 945892574 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7075545726 | ||||||||
FaxNumber: | 7075545102 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/13/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN 559664 | CA | X |   | Nursing Service Providers | Registered Nurse |   | 367500000X | NA 2547 | CA | X |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
No ID Information.