Healthcare Provider Details

I. General information

NPI: 1942081674
Provider Name (Legal Business Name): JAZZMYN RACQUEL ESQUIVEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16168 BEACH BLVD
HUNTINGTON BEACH CA
92647-3816
US

IV. Provider business mailing address

4332 GIRD AVE
CHINO HILLS CA
91709-3016
US

V. Phone/Fax

Practice location:
  • Phone: 714-849-4550
  • Fax:
Mailing address:
  • Phone: 626-733-6815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number130717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: