Provider Demographics
NPI:1386375459
Name:ESPERICUETA CEDANO, CLARITZA
Entity type:Individual
Prefix:
First Name:CLARITZA
Middle Name:
Last Name:ESPERICUETA CEDANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 BROAD AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-4555
Mailing Address - Country:US
Mailing Address - Phone:562-417-5594
Mailing Address - Fax:
Practice Address - Street 1:20695 S WESTERN AVE STE 132
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1834
Practice Address - Country:US
Practice Address - Phone:562-533-3920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator