Provider Demographics
NPI:1013218627
Name:OMAR E ESPINOSA MD INC
Entity Type:Organization
Organization Name:OMAR E ESPINOSA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:ESPINOSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-387-9251
Mailing Address - Street 1:3030 W TEMPLE ST
Mailing Address - Street 2:106
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4533
Mailing Address - Country:US
Mailing Address - Phone:213-387-9251
Mailing Address - Fax:213-387-9241
Practice Address - Street 1:3030 W TEMPLE ST
Practice Address - Street 2:106
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4533
Practice Address - Country:US
Practice Address - Phone:213-387-9251
Practice Address - Fax:213-387-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23122208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23122Medicare Oscar/Certification