Healthcare Provider Details

I. General information

NPI: 1891469680
Provider Name (Legal Business Name): TERESA MARIE ESQUIBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10251 N 35TH AVE
PHOENIX AZ
85051-1305
US

IV. Provider business mailing address

28909 N 66TH AVE
PHOENIX AZ
85083-7729
US

V. Phone/Fax

Practice location:
  • Phone: 602-995-9406
  • Fax:
Mailing address:
  • Phone: 602-750-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number137720
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: