Provider Demographics
NPI:1477584829
Name:ESPINOSA, ANDREA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 W CHERRY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3506
Mailing Address - Country:US
Mailing Address - Phone:559-784-2437
Mailing Address - Fax:559-784-2734
Practice Address - Street 1:198 W. CHERRY AVE SUITE B
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3506
Practice Address - Country:US
Practice Address - Phone:559-784-2437
Practice Address - Fax:559-784-2734
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75393174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA201063572OtherTAX ID
00G753930Medicare ID - Type Unspecified
CA201063572OtherTAX ID