Healthcare Provider Details

I. General information

NPI: 1699589663
Provider Name (Legal Business Name): VIRIDIANA ESPINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2025
Last Update Date: 02/01/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S LAKE AVE STE 300
PASADENA CA
91101-3009
US

IV. Provider business mailing address

225 S LAKE AVE STE 300
PASADENA CA
91101-3009
US

V. Phone/Fax

Practice location:
  • Phone: 626-410-0299
  • Fax:
Mailing address:
  • Phone: 626-410-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberY1749596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: