Healthcare Provider Details

I. General information

NPI: 1790878585
Provider Name (Legal Business Name): JOSE ANTONIO ESQUIVIAS M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/07/2024
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 E BALL RD STE 200
ANAHEIM CA
92806-5157
US

IV. Provider business mailing address

2035 E BALL RD STE 200
ANAHEIM CA
92806-5157
US

V. Phone/Fax

Practice location:
  • Phone: 714-517-6300
  • Fax: 714-517-6306
Mailing address:
  • Phone: 714-517-6300
  • Fax: 714-517-6306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT129532
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: