Provider Demographics
NPI:1417577677
Name:ESPITIA, IRENE ISABELLE
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:ISABELLE
Last Name:ESPITIA
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 1:7974 LA HABRA CIR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-2415
Mailing Address - Country:US
Mailing Address - Phone:714-457-7160
Mailing Address - Fax:
Practice Address - Street 1:12552 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-4013
Practice Address - Country:US
Practice Address - Phone:949-329-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA60432355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant