Provider Demographics
NPI:1831493980
Name:ESPANA, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ESPANA
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 1:3500 OVERLAND AVE
Mailing Address - Street 2:230
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-5695
Mailing Address - Country:US
Mailing Address - Phone:310-202-0056
Mailing Address - Fax:310-202-0057
Practice Address - Street 1:3500 OVERLAND AVE
Practice Address - Street 2:230
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-5695
Practice Address - Country:US
Practice Address - Phone:310-202-0056
Practice Address - Fax:310-202-0057
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1649225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist