Healthcare Provider Details

I. General information

NPI: 1063303626
Provider Name (Legal Business Name): ITZI ESPINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 W 95TH ST
OAK LAWN IL
60453-2359
US

IV. Provider business mailing address

5038 W 22ND PL
CICERO IL
60804-2919
US

V. Phone/Fax

Practice location:
  • Phone: 855-528-8476
  • Fax:
Mailing address:
  • Phone: 708-218-1189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: