Healthcare Provider Details

I. General information

NPI: 1912313867
Provider Name (Legal Business Name): JULIANA ESPINOSA AYALA M.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 11/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E CHAPMAN AVE
FULLERTON CA
92831-3839
US

IV. Provider business mailing address

PO BOX 919
FULLERTON CA
92836-0919
US

V. Phone/Fax

Practice location:
  • Phone: 714-680-8268
  • Fax: 714-680-8233
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 Code1041C0700X
TaxonomyClinical Social Worker
License Number64215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: