Provider Demographics
NPI:1417235706
Name:ESPINOSA, SANDRA LUZ (NNP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LUZ
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:LUZ
Other - Last Name:VILLAR-MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:14445 OLIVE VIEW DRIVE
Mailing Address - Street 2:OLIVE VEIW - UCLA MEDICAL CENTER
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342
Mailing Address - Country:US
Mailing Address - Phone:818-364-3031
Mailing Address - Fax:818-364-4593
Practice Address - Street 1:14445 OLIVE VIEW DRIVE
Practice Address - Street 2:OLIVE VEIW - UCLA MEDICAL CENTER
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342
Practice Address - Country:US
Practice Address - Phone:818-364-3031
Practice Address - Fax:818-364-4593
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19659363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner