Healthcare Provider Details

I. General information

NPI: 1922984012
Provider Name (Legal Business Name): HENRY ESPINOZA ANGEL PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 N DAISY AVE
PASADENA CA
91107-3704
US

IV. Provider business mailing address

16429 VICTORY BLVD APT 1
VAN NUYS CA
91406-5843
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-2871
  • Fax:
Mailing address:
  • Phone: 818-817-1472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number220267046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: