Provider Demographics
NPI:1124998604
Name:DIAZ-ESPIQUE, GENESIS GABRIELA
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:GABRIELA
Last Name:DIAZ-ESPIQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 E BRIAR OAKS DR APT D
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-4227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10350 E BRIAR OAKS DR APT D
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-4227
Practice Address - Country:US
Practice Address - Phone:562-294-9233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-10
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95037542363L00000X
CA95205222163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse