Healthcare Provider Details

I. General information

NPI: 1497309504
Provider Name (Legal Business Name): JOHN SERNA ESPARZA ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9829 CARMENITA RD STE H
WHITTIER CA
90605-3262
US

IV. Provider business mailing address

273 S POPLAR AVE APT 5
BREA CA
92821-8501
US

V. Phone/Fax

Practice location:
  • Phone: 562-907-7429
  • Fax:
Mailing address:
  • Phone: 714-770-1858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: