Provider Demographics
NPI:1285398701
Name:ESPINUEVA, JILLIAN MAE
Entity type:Individual
Prefix:
First Name:JILLIAN MAE
Middle Name:
Last Name:ESPINUEVA
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 1:2500 N PALM CANYON DR STE A4
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-1866
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 N PALM CANYON DR STE A4
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-1866
Practice Address - Country:US
Practice Address - Phone:760-424-5602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-30
Last Update Date:2025-09-23
Deactivation Date:2025-05-28
Deactivation Code:
Reactivation Date:2025-09-23
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program