Individual
COLLEEN GUSTAFSON ESPENSCHIED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C.
Contact information
Practice address
2017 1ST AVE, SAN DIEGO, CA 92101-2033
(619) 881-4577
(619) 231-1031
Mailing address
FILE 54433, LOS ANGELES, CA 90074-0001
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA17108
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA17108
—
CA
Enumeration date
07/25/2006
Last updated
04/04/2013
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