Provider Demographics
NPI:1699737924
Name:ESPINOSA, JOE H III (IDC)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:H
Last Name:ESPINOSA
Suffix:III
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 SAN JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6024
Mailing Address - Country:US
Mailing Address - Phone:626-222-3358
Mailing Address - Fax:619-556-7962
Practice Address - Street 1:3975 NORMAN SCOTT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-5523
Practice Address - Country:US
Practice Address - Phone:619-556-6592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman