Healthcare Provider Details

I. General information

NPI: 1205466802
Provider Name (Legal Business Name): ELIZABETH C ESQUEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 S PARALLEL AVE
FRESNO CA
93721-2404
US

IV. Provider business mailing address

42 CLAREMONT AVE
SANGER CA
93657-3852
US

V. Phone/Fax

Practice location:
  • Phone: 559-490-7080
  • Fax:
Mailing address:
  • Phone: 559-579-5756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: