Healthcare Provider Details

I. General information

NPI: 1912628363
Provider Name (Legal Business Name): ELIZABETH ESQUIVEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16580 HARBOR BLVD STE O
FOUNTAIN VALLEY CA
92708-1396
US

IV. Provider business mailing address

16580 HARBOR BLVD STE O
FOUNTAIN VALLEY CA
92708-1396
US

V. Phone/Fax

Practice location:
  • Phone: 714-975-5201
  • Fax:
Mailing address:
  • Phone: 714-975-5201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number124359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: