Healthcare Provider Details

I. General information

NPI: 1649686023
Provider Name (Legal Business Name): VALERIA EDITH ESPITIA B.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E CHAPMAN AVE STE 203
FULLERTON CA
92831-3846
US

IV. Provider business mailing address

PO BOX 919
FULLERTON CA
92836-0919
US

V. Phone/Fax

Practice location:
  • Phone: 714-680-8268
  • Fax:
Mailing address:
  • Phone: 714-680-8268
  • Fax: 714-680-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: