Healthcare Provider Details

I. General information

NPI: 1275853665
Provider Name (Legal Business Name): MAYRA MASSIEL ESQUIVEL ULTRASOUND TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13040 ARDIS AVE
DOWNEY CA
90242-4808
US

IV. Provider business mailing address

13040 ARDIS AVE
DOWNEY CA
90242-4808
US

V. Phone/Fax

Practice location:
  • Phone: 562-419-4641
  • Fax:
Mailing address:
  • Phone: 562-419-4641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: