Healthcare Provider Details

I. General information

NPI: 1639557655
Provider Name (Legal Business Name): ESPERANZA THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3293 WHITEASH
CLOVIS CA
93619
US

IV. Provider business mailing address

3293 WHITEASH
CLOVIS CA
93619
US

V. Phone/Fax

Practice location:
  • Phone: 559-916-4446
  • Fax:
Mailing address:
  • Phone: 559-916-4446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number422744
License Number StateCA

VIII. Authorized Official

Name: VANESSA R AVILA
Title or Position: CEO
Credential: BCBA
Phone: 559-916-4446