Healthcare Provider Details

I. General information

NPI: 1457780223
Provider Name (Legal Business Name): OLIVIA ESPINOSA BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14515 HAMLIN ST SUITE 200
VAN NUYS CA
91411-1608
US

IV. Provider business mailing address

14515 HAMLIN ST SUITE 200
VAN NUYS CA
91411-1608
US

V. Phone/Fax

Practice location:
  • Phone: 818-374-5383
  • Fax: 818-374-5388
Mailing address:
  • Phone: 818-374-5383
  • Fax: 818-374-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: