Provider Demographics
NPI:1457357220
Name:ESPINOSA, DAVID PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:ESPINOSA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 N IMPERIAL AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-1916
Mailing Address - Country:US
Mailing Address - Phone:760-352-7460
Mailing Address - Fax:760-352-7017
Practice Address - Street 1:828 N IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-1916
Practice Address - Country:US
Practice Address - Phone:760-352-7460
Practice Address - Fax:760-352-7017
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6024T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457357220Medicaid
CAT10204Medicare UPIN
CA1457357220Medicaid