Basic Information
| Provider Information | |||||||||
| NPI: | 1174182265 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ESPINOZA | ||||||||
| FirstName: | JESUS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 TENNESSEE ST APT A | ||||||||
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| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923734485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095038648 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11234 ANDERSON ST | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923542804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095584000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2019 | ||||||||
| LastUpdateDate: | 06/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.