Healthcare Provider Details

I. General information

NPI: 1700206711
Provider Name (Legal Business Name): GEORGINA ESPINOZA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GEORGINA ESPINOZA

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 E MONTE VISTA AVE
VACAVILLE CA
95688-3009
US

IV. Provider business mailing address

275 BECK AVE # MS 5-120
FAIRFIELD CA
94533-6804
US

V. Phone/Fax

Practice location:
  • Phone: 707-469-4557
  • Fax:
Mailing address:
  • Phone: 916-719-8656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number80590
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119922
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number80590
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number138669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: