Provider Demographics
NPI:1285678755
Name:ESPOSITO, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:ESPOSITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16702 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-5824
Mailing Address - Country:US
Mailing Address - Phone:714-367-5360
Mailing Address - Fax:714-635-5428
Practice Address - Street 1:1450 E 17TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8510
Practice Address - Country:US
Practice Address - Phone:714-953-5330
Practice Address - Fax:714-953-5503
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG44189207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG441891Medicare PIN
CAWG44189AMedicare ID - Type Unspecified
CAA92472Medicare UPIN