Provider Demographics
NPI:1588352512
Name:ESPARZA, EMILIANO CYRUS
Entity type:Individual
Prefix:MR
First Name:EMILIANO
Middle Name:CYRUS
Last Name:ESPARZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN BAUTISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95045-0532
Mailing Address - Country:US
Mailing Address - Phone:831-902-1379
Mailing Address - Fax:
Practice Address - Street 1:1121 FIRST ST
Practice Address - Street 2:
Practice Address - City:SAN JUAN BAUTISTA
Practice Address - State:CA
Practice Address - Zip Code:95045-3002
Practice Address - Country:US
Practice Address - Phone:831-902-1379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator