Healthcare Provider Details

I. General information

NPI: 1609431899
Provider Name (Legal Business Name): JUANITA IRENE ESPINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SCENIC DR BLDG A
MODESTO CA
95350-6131
US

IV. Provider business mailing address

800 SCENIC DR BLDG A
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-4982
  • Fax: 209-558-4332
Mailing address:
  • Phone: 209-525-4982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: