Healthcare Provider Details

I. General information

NPI: 1164838520
Provider Name (Legal Business Name): LINDA TATIANA ESPINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6187 ATLANTIC AVE # 2053
LONG BEACH CA
90805-2922
US

IV. Provider business mailing address

6187 ATLANTIC AVE # 2053
LONG BEACH CA
90805-2922
US

V. Phone/Fax

Practice location:
  • Phone: 562-245-9828
  • Fax: 866-280-7964
Mailing address:
  • Phone: 562-245-9828
  • Fax: 866-280-7964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number67202
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106792
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW88224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: