Provider Demographics
NPI:1609431899
Name:ESPINOZA, JUANITA IRENE
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:IRENE
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1119
Mailing Address - Country:US
Mailing Address - Phone:209-525-6150
Mailing Address - Fax:
Practice Address - Street 1:800 SCENIC DR BLDG A
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6131
Practice Address - Country:US
Practice Address - Phone:209-525-4982
Practice Address - Fax:209-558-4332
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16795OtherCOUNTY OF STANISLAUS