Healthcare Provider Details

I. General information

NPI: 1184233397
Provider Name (Legal Business Name): JOSE ESPINOZA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 09/19/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 17TH STREET- SCP BLANTON
BAKERSFIELD CA
93301-4533
US

IV. Provider business mailing address

1300 17TH STREET SCP BLANTON
BAKERSFIELD CA
93301-4533
US

V. Phone/Fax

Practice location:
  • Phone: 661-852-5661
  • Fax:
Mailing address:
  • Phone: 661-852-5660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW78734
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101459
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: