Provider Demographics
NPI:1962823260
Name:ESPINO, ELIZABETH ALICIA
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ALICIA
Last Name:ESPINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10925 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3044
Mailing Address - Country:US
Mailing Address - Phone:951-977-9991
Mailing Address - Fax:
Practice Address - Street 1:10828 RIO GRANDE LN
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5280
Practice Address - Country:US
Practice Address - Phone:209-409-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-04
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA631731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice