Provider Demographics
NPI:1417207051
Name:ESPINOZA, HUGO ALFREDO (STUDENT)
Entity Type:Individual
Prefix:
First Name:HUGO
Middle Name:ALFREDO
Last Name:ESPINOZA
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 E 7TH ST # 439
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-5003
Mailing Address - Country:US
Mailing Address - Phone:520-409-0476
Mailing Address - Fax:
Practice Address - Street 1:620 COURT ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504-1312
Practice Address - Country:US
Practice Address - Phone:434-485-8865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174031363LP0808X
CA803743390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program