Healthcare Provider Details

I. General information

NPI: 1306162235
Provider Name (Legal Business Name): MARTHA LUCIA ESQUIVEL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14901 CENTRAL AVE
CHINO CA
91710-9500
US

IV. Provider business mailing address

PO BOX 108
AZUSA CA
91702-0108
US

V. Phone/Fax

Practice location:
  • Phone: 909-597-1821
  • Fax:
Mailing address:
  • Phone: 909-245-6794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY24155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: