Provider Demographics
NPI:1699080747
Name:ESPINA, EILENE JIMENEZ (DMD)
Entity type:Individual
Prefix:
First Name:EILENE
Middle Name:JIMENEZ
Last Name:ESPINA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 WESTLAKE CTR
Mailing Address - Street 2:STE. 310 MEDICAL & DENTAL BUILDING
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1441
Mailing Address - Country:US
Mailing Address - Phone:650-585-4621
Mailing Address - Fax:650-585-4621
Practice Address - Street 1:341 WESTLAKE CTR
Practice Address - Street 2:STE. 310 MEDICAL & DENTAL BUILDING
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1441
Practice Address - Country:US
Practice Address - Phone:650-585-4621
Practice Address - Fax:650-585-4621
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice