Provider Demographics
NPI:1659451011
Name:ESPINOZA, GEORGE RAYMOND
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:RAYMOND
Last Name:ESPINOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4481 ELDER AVE
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2957
Mailing Address - Country:US
Mailing Address - Phone:562-212-9976
Mailing Address - Fax:562-596-1452
Practice Address - Street 1:4481 ELDER AVE
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2957
Practice Address - Country:US
Practice Address - Phone:562-212-9976
Practice Address - Fax:563-596-1452
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ20708ZOtherBLUE SHIELD
CAZZZ20708ZOtherBLUE SHIELD