Healthcare Provider Details

I. General information

NPI: 1225812134
Provider Name (Legal Business Name): NAVITICUS ESPINOSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1274 CENTER COURT DR
COVINA CA
91724-3668
US

IV. Provider business mailing address

1274 CENTER COURT DR
COVINA CA
91724-3668
US

V. Phone/Fax

Practice location:
  • Phone: 626-399-4999
  • Fax:
Mailing address:
  • Phone: 626-339-4999
  • 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: