Provider Demographics
NPI:1902304850
Name:ESPINOZA, LIDIA SAHRAI (COTA)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:SAHRAI
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43385 BUSINESS PARK DR STE 140
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5517
Mailing Address - Country:US
Mailing Address - Phone:951-383-8505
Mailing Address - Fax:619-374-7134
Practice Address - Street 1:43385 BUSINESS PARK DR STE 140
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5517
Practice Address - Country:US
Practice Address - Phone:951-383-8505
Practice Address - Fax:619-374-7134
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
CA489922224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician