Healthcare Provider Details

I. General information

NPI: 1174374938
Provider Name (Legal Business Name): EDUARDO ESQUIVEL TAPIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83053 AVENUE 48
COACHELLA CA
92236-9551
US

IV. Provider business mailing address

51416 CALLE ILOILO
LA QUINTA CA
92253-2913
US

V. Phone/Fax

Practice location:
  • Phone: 760-262-8050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number89293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: