Healthcare Provider Details

I. General information

NPI: 1134311202
Provider Name (Legal Business Name): CARLOS ESPINOZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 N BROADWAY SUITE 200
SANTA ANA CA
92706-2663
US

IV. Provider business mailing address

939 APPLETON AVE APT # 8
LONG BEACH CA
90802-5768
US

V. Phone/Fax

Practice location:
  • Phone: 714-221-6400
  • Fax: 714-221-6401
Mailing address:
  • Phone: 562-225-9526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: