Provider Demographics
NPI:1881005585
Name:ESPARZA-GONZALEZ, JUAN
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:ESPARZA-GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3365 E FLAMINGO RD STE 9
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7440
Mailing Address - Country:US
Mailing Address - Phone:702-865-5503
Mailing Address - Fax:702-868-5507
Practice Address - Street 1:3365 E FLAMINGO RD STE 9
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-7440
Practice Address - Country:US
Practice Address - Phone:702-865-5503
Practice Address - Fax:702-868-5507
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1073750626Medicaid