Healthcare Provider Details

I. General information

NPI: 1285923326
Provider Name (Legal Business Name): BENJAMIN ESPINOZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3787 S VERMONT AVE
LOS ANGELES CA
90007-4203
US

IV. Provider business mailing address

3787 S VERMONT AVE
LOS ANGELES CA
90007-4203
US

V. Phone/Fax

Practice location:
  • Phone: 323-766-2345
  • Fax:
Mailing address:
  • Phone: 323-766-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW25309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: