Provider Demographics
NPI:1275609778
Name:ESPINOSA, MARK ALAN (ATC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALAN
Last Name:ESPINOSA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5178
Mailing Address - Country:US
Mailing Address - Phone:951-990-7940
Mailing Address - Fax:
Practice Address - Street 1:900 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92521-9800
Practice Address - Country:US
Practice Address - Phone:951-990-0794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2019-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9909942255A2300X
CA0703021852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer