Basic Information
| Provider Information | |||||||||
| NPI: | 1487273959 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESPARZA | ||||||||
| FirstName: | ELISE | ||||||||
| MiddleName: | MARTINEZ | ||||||||
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| Credential: | CADC II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11227 VALLEY BLVD | ||||||||
| Address2: | |||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917313299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264440705 | ||||||||
| FaxNumber: | 6264440710 | ||||||||
| Practice Location | |||||||||
| Address1: | 11227 VALLEY BLVD | ||||||||
| Address2: | |||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917313299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264440705 | ||||||||
| FaxNumber: | 6264440710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2020 | ||||||||
| LastUpdateDate: | 04/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | AII054870418 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.