Healthcare Provider Details

I. General information

NPI: 1508640368
Provider Name (Legal Business Name): STEPHANIE SELENE ESQUIVEL RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 SAN MIGUEL DR
ARCADIA CA
91007-3020
US

IV. Provider business mailing address

306 SAN MIGUEL DR
ARCADIA CA
91007-3020
US

V. Phone/Fax

Practice location:
  • Phone: 323-482-4746
  • Fax:
Mailing address:
  • Phone: 323-482-4746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86372032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: