Healthcare Provider Details

I. General information

NPI: 1477859585
Provider Name (Legal Business Name): ANTONIO ESPARZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 PACIFIC AVE
LONG BEACH CA
90813-4228
US

IV. Provider business mailing address

944 PACIFIC AVE
LONG BEACH CA
90813-4228
US

V. Phone/Fax

Practice location:
  • Phone: 562-436-3533
  • Fax: 562-436-0043
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: