Provider Demographics
NPI:1316129406
Name:ESPINOZA, JORGE ANTONIO (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:ANTONIO
Last Name:ESPINOZA
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Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:8540 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3807
Mailing Address - Country:US
Mailing Address - Phone:310-568-8938
Mailing Address - Fax:310-665-9004
Practice Address - Street 1:8540 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 1100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3807
Practice Address - Country:US
Practice Address - Phone:310-568-8938
Practice Address - Fax:310-665-9004
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
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Provider Licenses
StateLicense IDTaxonomies
CAPA19511363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical