Provider Demographics
NPI:1033743380
Name:DE MESA, JOANNA VIOLET ESPLANA (NP-C)
Entity Type:Individual
Prefix:
First Name:JOANNA VIOLET
Middle Name:ESPLANA
Last Name:DE MESA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:510-869-6281
Mailing Address - Fax:510-869-6271
Practice Address - Street 1:3100 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3412
Practice Address - Country:US
Practice Address - Phone:510-869-8865
Practice Address - Fax:510-869-6271
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95014048OtherSTATE MEDICAL LICENSE