Healthcare Provider Details

I. General information

NPI: 1902328107
Provider Name (Legal Business Name): CYNTHIA ESQUIVEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11424 CHAMBERLAINE WAY STE 12
ADELANTO CA
92301-2869
US

IV. Provider business mailing address

PO BOX 1651
HELENDALE CA
92342-1651
US

V. Phone/Fax

Practice location:
  • Phone: 760-246-0934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number282410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: