Provider Demographics
NPI:1114683414
Name:ESPARZA, JOEL
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:ESPARZA
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 1:3435 NOVAK ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-1350
Mailing Address - Country:US
Mailing Address - Phone:310-613-4087
Mailing Address - Fax:
Practice Address - Street 1:3435 NOVAK ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-1350
Practice Address - Country:US
Practice Address - Phone:310-613-4087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty