Healthcare Provider Details

I. General information

NPI: 1699583096
Provider Name (Legal Business Name): ADRIANA ESPARZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 INGRAHAM ST
SAN DIEGO CA
92109-6713
US

IV. Provider business mailing address

2157 DOVETAIL CT UNIT 235
CHULA VISTA CA
91915-2943
US

V. Phone/Fax

Practice location:
  • Phone: 619-937-2055
  • Fax:
Mailing address:
  • Phone: 732-589-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number150468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: