Healthcare Provider Details

I. General information

NPI: 1881314003
Provider Name (Legal Business Name): JUSTINE M ESGUERRA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17042 BELLFLOWER BLVD
BELLFLOWER CA
90706-5950
US

IV. Provider business mailing address

817 W BEVERLY BLVD STE 201
MONTEBELLO CA
90640-4265
US

V. Phone/Fax

Practice location:
  • Phone: 562-991-1324
  • Fax: 562-502-9862
Mailing address:
  • Phone: 562-927-5820
  • Fax: 562-502-9862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA51047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: