Provider Demographics
NPI:1578648523
Name:RAYMOND J. ESPARZA MD INC.
Entity Type:Organization
Organization Name:RAYMOND J. ESPARZA MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:ESPARZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-394-0044
Mailing Address - Street 1:1330 W COVINA BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3200
Mailing Address - Country:US
Mailing Address - Phone:909-394-0044
Mailing Address - Fax:909-394-6133
Practice Address - Street 1:1330 W COVINA BLVD
Practice Address - Street 2:STE 203
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3200
Practice Address - Country:US
Practice Address - Phone:909-394-0044
Practice Address - Fax:909-394-6133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77594207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG55193Medicare UPIN
CAWG77594BMedicare ID - Type UnspecifiedPPIN