Provider Demographics
NPI:1801182407
Name:ESPINOZA, REGINA MARIE (MFT)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:MARIE
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 BAYSHORE HWY STE 123
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1506
Mailing Address - Country:US
Mailing Address - Phone:626-347-6504
Mailing Address - Fax:
Practice Address - Street 1:1601 BAYSHORE HWY STE 123
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:44010-1506
Practice Address - Country:US
Practice Address - Phone:626-347-6504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49880106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist