Provider Demographics
NPI:1184004384
Name:ESPARZA, DIVANA VILLARREAL
Entity Type:Individual
Prefix:
First Name:DIVANA
Middle Name:VILLARREAL
Last Name:ESPARZA
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 1:40835 AETNA SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-3079
Mailing Address - Country:US
Mailing Address - Phone:760-399-2019
Mailing Address - Fax:
Practice Address - Street 1:45325 BIRCH ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-3740
Practice Address - Country:US
Practice Address - Phone:760-399-2019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No172V00000XOther Service ProvidersCommunity Health Worker