Basic Information
| Provider Information | |||||||||
| NPI: | 1447788989 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARDONA ESPINOZA | ||||||||
| FirstName: | SAMARA | ||||||||
| MiddleName: | YAEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 172 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925020172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602890611 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1330 W RAMSEY ST # 100 | ||||||||
| Address2: | |||||||||
| City: | BANNING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922204477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9518497142 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2017 | ||||||||
| LastUpdateDate: | 04/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.