Provider Demographics
NPI:1932131638
Name:ESPARZA, MARCHELLE ETHEL (MPT, OCS)
Entity Type:Individual
Prefix:MRS
First Name:MARCHELLE
Middle Name:ETHEL
Last Name:ESPARZA
Suffix:
Gender:F
Credentials:MPT, OCS
Other - Prefix:MISS
Other - First Name:MARCHELLE
Other - Middle Name:ETHEL
Other - Last Name:BOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT, OCS
Mailing Address - Street 1:250 EL CAMINO REAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3655
Mailing Address - Country:US
Mailing Address - Phone:714-838-6999
Mailing Address - Fax:714-838-7099
Practice Address - Street 1:250 EL CAMINO REAL
Practice Address - Street 2:SUITE 100
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3655
Practice Address - Country:US
Practice Address - Phone:714-838-6999
Practice Address - Fax:714-838-7099
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT19874BMedicare ID - Type Unspecified