Healthcare Provider Details

I. General information

NPI: 1083115745
Provider Name (Legal Business Name): CHARISA ESPARZA BEHAVIOR TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7339 N 1ST ST
FRESNO CA
93720-2954
US

IV. Provider business mailing address

713 JAMES WAY
MADERA CA
93638-2165
US

V. Phone/Fax

Practice location:
  • Phone: 559-229-1540
  • Fax:
Mailing address:
  • Phone: 559-474-2693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: