Healthcare Provider Details

I. General information

NPI: 1245987114
Provider Name (Legal Business Name): ENRIQUETA JASMIN ESPINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13333 PALMDALE RD
VICTORVILLE CA
92392-9364
US

IV. Provider business mailing address

13333 PALMDALE RD
VICTORVILLE CA
92392-9364
US

V. Phone/Fax

Practice location:
  • Phone: 760-241-4917
  • Fax:
Mailing address:
  • Phone: 760-241-4917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: