Healthcare Provider Details

I. General information

NPI: 1780780346
Provider Name (Legal Business Name): JUAN DANIEL ESPITIA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S 5TH AVE
YUMA AZ
85364-4608
US

IV. Provider business mailing address

1959 S NAPLES AVE
YUMA AZ
85364-5030
US

V. Phone/Fax

Practice location:
  • Phone: 928-261-6759
  • Fax: 928-336-1619
Mailing address:
  • Phone: 928-261-6759
  • Fax: 928-336-1619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 22914
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-2856
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: