Provider Demographics
NPI:1508436965
Name:CHELIN ESPINOZA, KARLA
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:CHELIN ESPINOZA
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 1:168 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-5813
Mailing Address - Country:US
Mailing Address - Phone:631-835-1845
Mailing Address - Fax:
Practice Address - Street 1:168 BROADWAY
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-5813
Practice Address - Country:US
Practice Address - Phone:631-835-1845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator