Provider Demographics
NPI:1902370794
Name:ESPINOZA, DESIREE (RADT-I)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:RADT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 E THOMPSON BLVD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3008
Mailing Address - Country:US
Mailing Address - Phone:805-641-9100
Mailing Address - Fax:805-641-9010
Practice Address - Street 1:955 E THOMPSON BLVD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-3008
Practice Address - Country:US
Practice Address - Phone:805-641-9100
Practice Address - Fax:805-641-9010
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)