1629478060 NPI number — DR. JENINE S ESMAIL O.D.

Table of content: DR. JENINE S ESMAIL O.D. (NPI 1629478060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629478060 NPI number — DR. JENINE S ESMAIL O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESMAIL
Provider First Name:
JENINE
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESMAIL
Provider Other First Name:
JENINE-FELICIA
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1629478060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26691 PLAZA DRIVE, SUITE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92691
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-364-0225
Provider Business Mailing Address Fax Number:
949-364-9014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26691 PLAZA DRIVE
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-364-0225
Provider Business Practice Location Address Fax Number:
949-364-9014
Provider Enumeration Date:
09/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  14916 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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