Provider Demographics
NPI:1104429323
Name:ESPINOZA, CRYSTAL ANN (MA)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANN
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7295
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92834-7295
Mailing Address - Country:US
Mailing Address - Phone:562-324-8421
Mailing Address - Fax:
Practice Address - Street 1:107 N MONTAGUE AVE APT C
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3952
Practice Address - Country:US
Practice Address - Phone:562-324-8421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111880106H00000X
CA129024106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist