Healthcare Provider Details

I. General information

NPI: 1801443379
Provider Name (Legal Business Name): NANCY WALLIN ESPINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17215 STARK AVE
CERRITOS CA
90703-1821
US

IV. Provider business mailing address

11432 SOUTH ST #383
CERRITOS CA
90703-6611
US

V. Phone/Fax

Practice location:
  • Phone: 562-353-7261
  • Fax:
Mailing address:
  • Phone: 562-400-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT126224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: