Provider Demographics
NPI:1962606145
Name:ESPITIA, MARIO (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:ESPITIA
Suffix:
Gender:M
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 EASTLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-1019
Mailing Address - Country:US
Mailing Address - Phone:323-865-3782
Mailing Address - Fax:323-865-9214
Practice Address - Street 1:1441 EASTLAKE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-1019
Practice Address - Country:US
Practice Address - Phone:323-865-3782
Practice Address - Fax:323-865-9214
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA683661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical