Healthcare Provider Details

I. General information

NPI: 1023761954
Provider Name (Legal Business Name): MICHELLE ESPINO AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CALIFORNIA AVE STE 100
CORONA CA
92881-6472
US

IV. Provider business mailing address

1101 CALIFORNIA AVE STE 100
CORONA CA
92881-6472
US

V. Phone/Fax

Practice location:
  • Phone: 714-584-9700
  • Fax:
Mailing address:
  • Phone: 714-584-9700
  • Fax: 714-784-7516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number165158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: