Healthcare Provider Details

I. General information

NPI: 1750451159
Provider Name (Legal Business Name): NICOLE DEAN ESQUEDA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N IRWIN ST
HANFORD CA
93230-4537
US

IV. Provider business mailing address

115 N IRWIN ST
HANFORD CA
93230-4537
US

V. Phone/Fax

Practice location:
  • Phone: 559-584-4227
  • Fax: 559-584-4785
Mailing address:
  • Phone: 559-584-4227
  • Fax: 559-584-4785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12569T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: