Healthcare Provider Details

I. General information

NPI: 1396149746
Provider Name (Legal Business Name): ANDRA ESPINAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9340 KLUSMAN AVE
RANCHO CUCAMONGA CA
91730-5605
US

IV. Provider business mailing address

9340 KLUSMAN AVE
RANCHO CUCAMONGA CA
91730-5605
US

V. Phone/Fax

Practice location:
  • Phone: 909-200-6329
  • Fax: 909-463-2035
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number10620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: