Provider Demographics
NPI:1013186600
Name:ESPIRITU, ERIC JAMES (PTA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JAMES
Last Name:ESPIRITU
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5417 COCHRAN ST
Mailing Address - Street 2:APT # 56
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-6582
Mailing Address - Country:US
Mailing Address - Phone:216-225-4856
Mailing Address - Fax:
Practice Address - Street 1:5601 DESOTO AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91365-4084
Practice Address - Country:US
Practice Address - Phone:818-719-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8584225200000X
OH4210225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant