Healthcare Provider Details

I. General information

NPI: 1467170274
Provider Name (Legal Business Name): MARICELA ESPINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LINCOLN AVE APT 2
WOODLAND CA
95695-3850
US

IV. Provider business mailing address

7415 HENRIETTA DR
SACRAMENTO CA
95822-5142
US

V. Phone/Fax

Practice location:
  • Phone: 916-520-7399
  • Fax:
Mailing address:
  • Phone: 916-520-7399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number42244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: