Healthcare Provider Details

I. General information

NPI: 1053998450
Provider Name (Legal Business Name): IRENA ESPANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W CAMERON AVE STE 215
WEST COVINA CA
91790-2724
US

IV. Provider business mailing address

1501 W CAMERON AVE STE 215
WEST COVINA CA
91790-2724
US

V. Phone/Fax

Practice location:
  • Phone: 323-302-9997
  • Fax: 818-736-4189
Mailing address:
  • Phone: 323-302-9997
  • Fax: 323-866-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-49596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: