Healthcare Provider Details

I. General information

NPI: 1124825203
Provider Name (Legal Business Name): SANDRA ESPINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 N MOUNTAIN AVE
ONTARIO CA
91762-1128
US

IV. Provider business mailing address

19433 KATYDID AVE
BLOOMINGTON CA
92316-3805
US

V. Phone/Fax

Practice location:
  • Phone: 909-949-9299
  • Fax:
Mailing address:
  • Phone: 909-342-8410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: