Healthcare Provider Details

I. General information

NPI: 1538902820
Provider Name (Legal Business Name): LUNA YAYLIN ESPARZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CLAYTON RD
SAN JOSE CA
95127-4307
US

IV. Provider business mailing address

350 FAIRWAY DR STE 101
DEERFIELD BCH FL
33441-1834
US

V. Phone/Fax

Practice location:
  • Phone: 901-724-4537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: