Provider Demographics
NPI:1548256217
Name:ESPINOZA, ROLANDO CARLOS (PHD)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:CARLOS
Last Name:ESPINOZA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 E WORKMAN ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3500
Mailing Address - Country:US
Mailing Address - Phone:626-966-0318
Mailing Address - Fax:626-966-4560
Practice Address - Street 1:271 E WORKMAN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3500
Practice Address - Country:US
Practice Address - Phone:626-966-0318
Practice Address - Fax:626-966-4560
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6239103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY062390Medicaid
CAR33513Medicare UPIN
CAPSY062390Medicaid