Healthcare Provider Details

I. General information

NPI: 1649017948
Provider Name (Legal Business Name): MR. DAVID ANTHONY ESPINO SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 W HEDDING ST
SAN JOSE CA
95110-1768
US

IV. Provider business mailing address

1049 GLENFINNAN DR
SAN JOSE CA
95122-3710
US

V. Phone/Fax

Practice location:
  • Phone: 669-307-5905
  • Fax:
Mailing address:
  • Phone: 669-307-5905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: