Healthcare Provider Details

I. General information

NPI: 1679822209
Provider Name (Legal Business Name): MARCIA ESPINOZA RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 CENTRAL AVE 58
RIVERSIDE CA
92507
US

IV. Provider business mailing address

375 CENTRAL AVE 58
RIVERSIDE CA
92507
US

V. Phone/Fax

Practice location:
  • Phone: 909-559-5129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHAP 428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: