Provider Demographics
NPI:1124832449
Name:ESPINO, ELISHA MARIEL (FNP)
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:MARIEL
Last Name:ESPINO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5563 SORIA DR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-7646
Mailing Address - Country:US
Mailing Address - Phone:253-970-2886
Mailing Address - Fax:
Practice Address - Street 1:412 W CARROLL AVE STE 204
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4711
Practice Address - Country:US
Practice Address - Phone:626-852-8873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031730363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner