Healthcare Provider Details

I. General information

NPI: 1083735831
Provider Name (Legal Business Name): CLARA ESPINOZA BALANCIO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS CLARA SUZARA ESPINOZA

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 GREGORY LN STE# 9
PLEASANT HILL CA
94523-4981
US

IV. Provider business mailing address

91 GREGORY LN STE# 9
PLEASANT HILL CA
94523-4981
US

V. Phone/Fax

Practice location:
  • Phone: 925-671-9177
  • Fax: 925-726-2479
Mailing address:
  • Phone: 925-671-9177
  • Fax: 925-726-2479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number49040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: