Healthcare Provider Details

I. General information

NPI: 1548664204
Provider Name (Legal Business Name): MONIQUE ESQUIVEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N STATE COLLEGE BLVD
ANAHEIM CA
92806-2915
US

IV. Provider business mailing address

321 N STATE COLLEGE BLVD
ANAHEIM CA
92806-2915
US

V. Phone/Fax

Practice location:
  • Phone: 714-687-0077
  • Fax: 562-687-0691
Mailing address:
  • Phone: 714-687-0077
  • Fax: 562-687-0691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: