Healthcare Provider Details

I. General information

NPI: 1700101276
Provider Name (Legal Business Name): MARY ESPINOZA M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14724 VENTURA BLVD STE 1100
SHERMAN OAKS CA
91403-3501
US

IV. Provider business mailing address

29755 CASTLEBURY PL
CASTAIC CA
91384-3823
US

V. Phone/Fax

Practice location:
  • Phone: 310-551-7705
  • Fax: 661-295-8752
Mailing address:
  • Phone: 818-370-3108
  • Fax: 661-295-8752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 25459
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: