Healthcare Provider Details

I. General information

NPI: 1407672074
Provider Name (Legal Business Name): CRISTINA E ESQUIVEL RADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2024
Last Update Date: 11/28/2024
Certification Date: 11/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 N WESTON PL
HEMET CA
92543-3006
US

IV. Provider business mailing address

1825 S SANTA FE AVE APT 122
SAN JACINTO CA
92583-5022
US

V. Phone/Fax

Practice location:
  • Phone: 951-652-2811
  • Fax:
Mailing address:
  • Phone: 951-312-5967
  • 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: