Healthcare Provider Details

I. General information

NPI: 1689495137
Provider Name (Legal Business Name): KRISTEN ELAINE ESPARZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1247 CENTER COURT DRIVE SUITE 211
COVINA CA
91724
US

IV. Provider business mailing address

1425 SAN MIGUEL AVE
SPRING VALLEY CA
91977-4463
US

V. Phone/Fax

Practice location:
  • Phone: 626-339-4999
  • Fax:
Mailing address:
  • Phone: 619-916-6391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: