Provider Demographics
NPI:1316783871
Name:ESPINOZA, TIFFANY KIMBERLEE DENEE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:KIMBERLEE DENEE
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18088 MARINER DRIVE
Mailing Address - Street 2:7617 SVL BOX
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395
Mailing Address - Country:US
Mailing Address - Phone:760-983-6942
Mailing Address - Fax:
Practice Address - Street 1:16209 KAMANA RD STE 107
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1394
Practice Address - Country:US
Practice Address - Phone:760-983-6942
Practice Address - Fax:760-979-1776
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP29309235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA93-1383839OtherS-CORP