Healthcare Provider Details

I. General information

NPI: 1861754806
Provider Name (Legal Business Name): LIZET ESPINOZA BANDE M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 S BROADWAY
SANTA ANA CA
92707-2253
US

IV. Provider business mailing address

5132 GLEN ALBYN LN
ORANGE CA
92869-1251
US

V. Phone/Fax

Practice location:
  • Phone: 714-919-0280
  • Fax:
Mailing address:
  • Phone: 916-743-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number080015106
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: