Provider Demographics
NPI:1134320716
Name:MARIA A ESPINOZA MD, INC
Entity Type:Organization
Organization Name:MARIA A ESPINOZA MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-483-2222
Mailing Address - Street 1:PO BOX 4758
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-0758
Mailing Address - Country:US
Mailing Address - Phone:213-483-2222
Mailing Address - Fax:213-483-6161
Practice Address - Street 1:2151 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3121
Practice Address - Country:US
Practice Address - Phone:213-483-2222
Practice Address - Fax:213-483-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A658460OtherBLUE SHIELD
CA00A658460Medicaid
CA00A658460OtherBLUE SHIELD
CA00A658460Medicaid
CAWA65846EMedicare ID - Type UnspecifiedRENDERING PROVIDER