Provider Demographics
NPI:1336489814
Name:ESPOSO, WILFRENGERARD P (NP)
Entity Type:Individual
Prefix:
First Name:WILFRENGERARD
Middle Name:P
Last Name:ESPOSO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4501 X ST
Mailing Address - Street 2:SUITE 3016
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2229
Mailing Address - Country:US
Mailing Address - Phone:916-734-3772
Mailing Address - Fax:916-734-7946
Practice Address - Street 1:4501 X ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2229
Practice Address - Country:US
Practice Address - Phone:916-734-5959
Practice Address - Fax:916-703-5265
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP20761363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner