Provider Demographics
NPI:1053340562
Name:LO, ESTHER Y (NP)
Entity type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:Y
Last Name:LO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:909-498-2356
Mailing Address - Fax:877-824-9080
Practice Address - Street 1:1181 N MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-2574
Practice Address - Country:US
Practice Address - Phone:909-498-2356
Practice Address - Fax:877-824-9080
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10381363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEFF.10/21/13-COLTONMedicaid
CAEFF 2/20/13 RIALTOMedicaid
CAEFF. 5/17/13-SAN BERMedicaid
CAP01282960/DU4034OtherRAILROAD MEDICARE
CAEFF.4/23/13-MORENOVAMedicaid
CAEFF.4/23/13-N.RIVERSMedicaid
CAEFF. 5/17/13-SAN BERMedicaid
CAP26356Medicare UPIN
CAEFF 2/20/13 RIALTOMedicaid