Healthcare Provider Details

I. General information

NPI: 1780195537
Provider Name (Legal Business Name): VANESSA ESPINOZA P.G.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 14TH ST
RIVERSIDE CA
92501-3815
US

IV. Provider business mailing address

PO BOX 1405
RIVERSIDE CA
92502-1405
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-4687
  • Fax:
Mailing address:
  • Phone: 951-955-4687
  • Fax: 951-955-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: