Healthcare Provider Details

I. General information

NPI: 1780961698
Provider Name (Legal Business Name): JOHN ESQUIVEL LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2011
Last Update Date: 11/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 E ORANGETHORPE AVE APT E105
ANAHEIM CA
92807-1564
US

IV. Provider business mailing address

5601 E ORANGETHORPE AVE APT E105
ANAHEIM CA
92807-1564
US

V. Phone/Fax

Practice location:
  • Phone: 714-747-5702
  • Fax: 714-485-2807
Mailing address:
  • Phone: 714-747-5702
  • Fax: 714-485-2807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberVN262105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: