Healthcare Provider Details

I. General information

NPI: 1932867835
Provider Name (Legal Business Name): ESPINOZA PSYCHOLOGICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15615 ALTON PKWY STE 450
IRVINE CA
92618-3308
US

IV. Provider business mailing address

27 HOMESTEAD DR
TRABUCO CANYON CA
92679-5333
US

V. Phone/Fax

Practice location:
  • Phone: 949-689-5402
  • Fax: 949-606-8928
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. REGINALDO CHASE ESPINOZA
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 949-689-5402