Provider Demographics
NPI:1619632833
Name:ROY, VIRGIE ESPIRITU (RN BSN)
Entity Type:Individual
Prefix:
First Name:VIRGIE
Middle Name:ESPIRITU
Last Name:ROY
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:VIRGIE
Other - Middle Name:SANTOS
Other - Last Name:ESPIRITU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:4151 ROWLAND DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-9799
Mailing Address - Country:US
Mailing Address - Phone:650-861-2938
Mailing Address - Fax:
Practice Address - Street 1:4151 ROWLAND DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-9799
Practice Address - Country:US
Practice Address - Phone:650-861-2938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY693245163WC0200X
TX860810163WC0200X
FLRN9380526163WC0200X
NMRN71814163WC0200X
CA95042997163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY8881922OtherDRIVERS LICENSE