Healthcare Provider Details

I. General information

NPI: 1386235265
Provider Name (Legal Business Name): LAUREN MARIE ESQUEDA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E ALOSTA AVE
AZUSA CA
91702-2701
US

IV. Provider business mailing address

901 E ALOSTA AVE
AZUSA CA
91702-2701
US

V. Phone/Fax

Practice location:
  • Phone: 626-815-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: