Healthcare Provider Details

I. General information

NPI: 1841805793
Provider Name (Legal Business Name): HANNAH NICOLE ESQUIVEL RADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18612 SANTA ANA AVE
BLOOMINGTON CA
92316-2639
US

IV. Provider business mailing address

20700 SAN JOSE HILLS RD APT 168
WALNUT CA
91789-1308
US

V. Phone/Fax

Practice location:
  • Phone: 909-421-7120
  • Fax: 909-421-7128
Mailing address:
  • Phone: 209-347-6917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: