Healthcare Provider Details

I. General information

NPI: 1063395507
Provider Name (Legal Business Name): TONALLI ESPINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39155 LIBERTY ST STE E500
FREMONT CA
94538-1516
US

IV. Provider business mailing address

344 N 5TH ST APT 5
SAN JOSE CA
95112-5236
US

V. Phone/Fax

Practice location:
  • Phone: 510-574-2100
  • Fax:
Mailing address:
  • Phone: 562-884-1255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: