Provider Demographics
NPI:1679898308
Name:ESPARZA, OVET (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:OVET
Middle Name:
Last Name:ESPARZA
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 LAUREL ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-5120
Mailing Address - Country:US
Mailing Address - Phone:928-271-9508
Mailing Address - Fax:
Practice Address - Street 1:200 JOSE FIGUERES AVE STE 490
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1595
Practice Address - Country:US
Practice Address - Phone:408-272-2252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 20860363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant