Provider Demographics
NPI:1053998450
Name:ESPANA, IRENA
Entity type:Individual
Prefix:
First Name:IRENA
Middle Name:
Last Name:ESPANA
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 1:1501 W CAMERON AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2724
Mailing Address - Country:US
Mailing Address - Phone:323-302-9997
Mailing Address - Fax:323-866-1881
Practice Address - Street 1:1501 W CAMERON AVE STE 215
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2724
Practice Address - Country:US
Practice Address - Phone:323-302-9997
Practice Address - Fax:818-736-4189
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X
CA1-21-49596103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst