Provider Demographics
NPI:1205030830
Name:VIDAL J. ESPELETA, M.D. INC., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:VIDAL J. ESPELETA, M.D. INC., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VIDAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ESPELETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-916-0022
Mailing Address - Street 1:PO BOX 3420
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92690-1420
Mailing Address - Country:US
Mailing Address - Phone:949-521-6060
Mailing Address - Fax:949-521-6063
Practice Address - Street 1:24411 HEALTH CENTER DR
Practice Address - Street 2:SUITE 620
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3651
Practice Address - Country:US
Practice Address - Phone:949-521-6060
Practice Address - Fax:949-521-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83599207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20927Medicare PIN