Provider Demographics
NPI:1912648684
Name:ESPINOSA, JUAN CARLOS (MD)
Entity type:Individual
Prefix:
First Name:JUAN CARLOS
Middle Name:
Last Name:ESPINOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6709 MARCELLE ST
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-4730
Mailing Address - Country:US
Mailing Address - Phone:562-307-1132
Mailing Address - Fax:
Practice Address - Street 1:1000 W CARSON ST # 492
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:424-306-7659
Practice Address - Fax:424-306-6633
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program