MEDICARE: LAURA ALEJANDRA ESQUER LASAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LASAC-15145	AZ

General Provider Information

NPI Number	:	1376055244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ALEJANDRA ESQUER LASAC

Provider Business Mailing Address
First Line	:	4343 N 21ST ST APT 214
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-0504
Country	:	US
Telephone Number	:	928-257-5830
Fax Number	:

Provider Business Practice Location Address
First Line	:	3550 E PINCHOT AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7434
Country	:	US
Telephone Number	:	602-957-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2017
Last Update Date	:	10/31/2017

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