Healthcare Provider Details

I. General information

NPI: 1154054583
Provider Name (Legal Business Name): MICHELLE ESQUIVIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2022
Last Update Date: 07/04/2022
Certification Date: 07/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16428 E KINGSTREE BLVD
FOUNTAIN HILLS AZ
85268-5440
US

IV. Provider business mailing address

161 CAMINO SAN XAVIER
RIO RICO AZ
85648-2904
US

V. Phone/Fax

Practice location:
  • Phone: 480-837-4565
  • Fax:
Mailing address:
  • Phone: 520-223-1888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: