MEDICARE: MR. FABIAN ESQUEDA P.A-C

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	363A00000X	Physician Assistant	15997	CA

General Provider Information

NPI Number	:	1902059629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FABIAN ESQUEDA P.A-C

Provider Business Mailing Address
First Line	:	13307 SAN ANTONIO DR
Second Line	:
City	:	NORWALK
State	:	CA
Zip	:	90650-2970
Country	:	US
Telephone Number	:	562-863-0124
Fax Number	:	562-868-6795

Provider Business Practice Location Address
First Line	:	13307 SAN ANTONIO DR
Second Line	:
City	:	NORWALK
State	:	CA
Zip	:	90650-2970
Country	:	US
Telephone Number	:	562-863-0124
Fax Number	:	562-868-6795

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

Provider Enumeration Date	:	10/25/2008
Last Update Date	:	10/25/2008

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