Provider Demographics
NPI:1336810225
Name:ESPARZA, PRISCILLA M
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:M
Last Name:ESPARZA
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 1:22228 GRACE AVE APT 204A
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-7298
Mailing Address - Country:US
Mailing Address - Phone:310-971-5175
Mailing Address - Fax:
Practice Address - Street 1:22228 GRACE AVE APT 204A
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-7298
Practice Address - Country:US
Practice Address - Phone:310-971-5175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician