Provider Demographics
NPI:1265113674
Name:ESPINOZA, JELY JALY
Entity type:Individual
Prefix:
First Name:JELY
Middle Name:JALY
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 E SCHOOL WAY
Mailing Address - Street 2:
Mailing Address - City:REDWOOD VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95470-9701
Mailing Address - Country:US
Mailing Address - Phone:707-513-0137
Mailing Address - Fax:
Practice Address - Street 1:635 E SCHOOL WAY
Practice Address - Street 2:
Practice Address - City:REDWOOD VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95470-9701
Practice Address - Country:US
Practice Address - Phone:707-513-0137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program