Healthcare Provider Details

I. General information

NPI: 1780246033
Provider Name (Legal Business Name): AZRIEL JAVAN ESQUIVEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2019
Last Update Date: 07/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

891 KUHN DR STE 110
CHULA VISTA CA
91914-3551
US

IV. Provider business mailing address

3214 CAGLE ST
NATIONAL CITY CA
91950-8111
US

V. Phone/Fax

Practice location:
  • Phone: 619-862-7070
  • Fax:
Mailing address:
  • Phone: 619-829-6292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: