Provider Demographics
NPI:1740435114
Name:LIZA ESPINOZA, DORIS MABEL PAMELA (MS, SLP, TSHH)
Entity type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:MABEL PAMELA
Last Name:LIZA ESPINOZA
Suffix:
Gender:F
Credentials:MS, SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 CRESCENT ST
Mailing Address - Street 2:APT. 1B
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-4304
Mailing Address - Country:US
Mailing Address - Phone:347-527-2055
Mailing Address - Fax:
Practice Address - Street 1:2038 CRESCENT ST
Practice Address - Street 2:APT. 1B
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-4304
Practice Address - Country:US
Practice Address - Phone:347-527-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015502235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist