Healthcare Provider Details

I. General information

NPI: 1881187037
Provider Name (Legal Business Name): ITZAYANA ESPINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 VIKING DR
SACRAMENTO CA
95827-2844
US

IV. Provider business mailing address

7415 HENRIETTA DR
SACRAMENTO CA
95822-5142
US

V. Phone/Fax

Practice location:
  • Phone: 916-912-0362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: