Healthcare Provider Details

I. General information

NPI: 1376876284
Provider Name (Legal Business Name): MISS YVONNE MICHELLE ESPERANZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 W STATE ST SUITE 201
EL CENTRO CA
92243-2845
US

IV. Provider business mailing address

1056 S 9TH ST
EL CENTRO CA
92243-3801
US

V. Phone/Fax

Practice location:
  • Phone: 760-336-2261
  • Fax:
Mailing address:
  • Phone: 760-336-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: