Healthcare Provider Details

I. General information

NPI: 1023503810
Provider Name (Legal Business Name): ARIEL ESQUIBEL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ARIEL WALKER

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 LAKE HAVASU AVE S
LAKE HAVASU CITY AZ
86403-9368
US

IV. Provider business mailing address

920 HARROD WAY
KINGMAN AZ
86401-5339
US

V. Phone/Fax

Practice location:
  • Phone: 928-680-1144
  • Fax:
Mailing address:
  • Phone: 928-727-3220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT34381-TLG
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002324
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: