Healthcare Provider Details

I. General information

NPI: 1669006516
Provider Name (Legal Business Name): MICHAEL ESPINOZA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2020
Last Update Date: 03/01/2020
Certification Date: 03/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 N LAKE AVE
PASADENA CA
91104-2387
US

IV. Provider business mailing address

3545 BROOKLINE AVE
ROSEMEAD CA
91770-2118
US

V. Phone/Fax

Practice location:
  • Phone: 626-798-7805
  • Fax:
Mailing address:
  • Phone: 626-673-7428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: