Healthcare Provider Details

I. General information

NPI: 1518009380
Provider Name (Legal Business Name): EVELYN ELIZABETH ESPINOZA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17707 STUDEBAKER RD STE 208
CERRITOS CA
90703-2640
US

IV. Provider business mailing address

17707 STUDEBAKER RD STE 208
CERRITOS CA
90703-2640
US

V. Phone/Fax

Practice location:
  • Phone: 562-402-0677
  • Fax: 562-924-6037
Mailing address:
  • Phone: 562-402-0677
  • Fax: 562-924-6037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY25971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: