Basic Information
| Provider Information | |||||||||
| NPI: | 1265868541 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESPARZA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | JANETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7237 GLADE AVE | ||||||||
| Address2: | |||||||||
| City: | CANOGA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913031105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183996546 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6800 OWENSMOUTH AVE STE 310 | ||||||||
| Address2: | |||||||||
| City: | CANOGA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913034245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183478565 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2013 | ||||||||
| LastUpdateDate: | 09/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.