Healthcare Provider Details

I. General information

NPI: 1770331977
Provider Name (Legal Business Name): SUSANNA ESPINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSANNA BARNETT

II. Dates (important events)

Enumeration Date: 05/11/2024
Last Update Date: 05/11/2024
Certification Date: 05/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44501 16TH ST W STE 107
LANCASTER CA
93534-2884
US

IV. Provider business mailing address

937 EUCLID AVE
BEAUMONT CA
92223-1847
US

V. Phone/Fax

Practice location:
  • Phone: 661-974-7033
  • Fax:
Mailing address:
  • Phone: 951-425-9265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number52195
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: