Healthcare Provider Details

I. General information

NPI: 1174162382
Provider Name (Legal Business Name): NOELLE COLLETTE ESQUER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17272 NEWHOPE ST STE G
FOUNTAIN VALLEY CA
92708-4210
US

IV. Provider business mailing address

PO BOX 8125
FOUNTAIN VALLEY CA
92728-8125
US

V. Phone/Fax

Practice location:
  • Phone: 714-754-7268
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number50403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: