Healthcare Provider Details

I. General information

NPI: 1821566936
Provider Name (Legal Business Name): LISA ESPINOZA SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 CALLE AMANECER
SAN CLEMENTE CA
92673-6250
US

IV. Provider business mailing address

12 MORNINGSTAR
DOVE CANYON CA
92679-3726
US

V. Phone/Fax

Practice location:
  • Phone: 949-498-5100
  • Fax:
Mailing address:
  • Phone: 949-278-5958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSPA5098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: