MEDICARE: DR. RICHARD ANDREW ESPINOZA PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY28726	CA

General Provider Information

NPI Number	:	1215376538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ANDREW ESPINOZA PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 78422
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-0422
Country	:	US
Telephone Number	:	323-508-7907
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 GLENDALE BLVD
Second Line	:	UNIT B
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1814
Country	:	US
Telephone Number	:	323-508-7907
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2013
Last Update Date	:	11/22/2016

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