Healthcare Provider Details

I. General information

NPI: 1386469039
Provider Name (Legal Business Name): MICHELLE ESPINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E MOUNTAIN VIEW ST STE 108
BARSTOW CA
92311-2814
US

IV. Provider business mailing address

17111 MELON AVE
FONTANA CA
92336-3256
US

V. Phone/Fax

Practice location:
  • Phone: 442-327-9172
  • Fax:
Mailing address:
  • Phone: 442-354-5497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: