Healthcare Provider Details

I. General information

NPI: 1225795867
Provider Name (Legal Business Name): SANDRA DAISY ESPINOZA-MONTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5985 W MAIN ST STE 101
KALAMAZOO MI
49009-8708
US

IV. Provider business mailing address

5985 W MAIN ST STE 101
KALAMAZOO MI
49009-8708
US

V. Phone/Fax

Practice location:
  • Phone: 269-459-1818
  • Fax: 269-365-9951
Mailing address:
  • Phone: 269-459-1818
  • Fax: 269-365-9951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6352000635
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: