Healthcare Provider Details

I. General information

NPI: 1194202606
Provider Name (Legal Business Name): CHRISTIAN ANDREW ESPINOZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3745 LONG BEACH BLVD STE 100
LONG BEACH CA
90807-3340
US

IV. Provider business mailing address

DEPT LA 22763
PASADENA CA
91185-2763
US

V. Phone/Fax

Practice location:
  • Phone: 866-523-4268
  • Fax:
Mailing address:
  • Phone: 866-523-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-58802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: