Healthcare Provider Details

I. General information

NPI: 1366281222
Provider Name (Legal Business Name): ALFONSO ESQUIVEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 LOMITA BLVD STE 101
HARBOR CITY CA
90710-2084
US

IV. Provider business mailing address

3540 REGATTA PL
OXNARD CA
93035-1613
US

V. Phone/Fax

Practice location:
  • Phone: 310-784-5800
  • Fax:
Mailing address:
  • Phone: 805-616-9064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number68699
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: