Healthcare Provider Details

I. General information

NPI: 1447017470
Provider Name (Legal Business Name): JACOB ANDREW ESQUEDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E MAIN ST STE 117
BARSTOW CA
92311-2365
US

IV. Provider business mailing address

222 E MAIN ST STE 117
BARSTOW CA
92311-2365
US

V. Phone/Fax

Practice location:
  • Phone: 760-255-1496
  • Fax:
Mailing address:
  • Phone: 760-255-1496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: