Healthcare Provider Details

I. General information

NPI: 1467312306
Provider Name (Legal Business Name): DANIELA ESPANA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 E KETTLEMAN LN
LODI CA
95240-6423
US

IV. Provider business mailing address

605 VIA PORLEZZA
CHULA VISTA CA
91914-5303
US

V. Phone/Fax

Practice location:
  • Phone: 209-642-8990
  • Fax:
Mailing address:
  • Phone: 619-799-9823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112505
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: