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General NPI Number Information
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NPI Number | 1639557655
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Entity Type | Organization
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Legal Business Name | ESPERANZA THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 05/11/2015
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Provider Practice Location Address
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Address Line | 3293 WHITEASH
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City | CLOVIS
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State | CA
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Zip | 93619
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Country | US
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Telephone | 559-916-4446
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Fax |
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Provider Business Mailing Address
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Address Line | 3293 WHITEASH
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City | CLOVIS
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State | CA
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Zip | 93619
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Country | US
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Telephone | 559-916-4446
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | VANESSA R AVILA
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Credential | BCBA
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Telephone | 559-916-4446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 422744
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License Number State | CA
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