Healthcare Provider Details

I. General information

NPI: 1497410641
Provider Name (Legal Business Name): MS. JENNIFER ESQUIVEL-PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 PALM AVE STE A
LA MESA CA
91941-6528
US

IV. Provider business mailing address

3245 UNIVERSITY AVE. SUITE 1, #485
SAN DIEGO CA
92104-2009
US

V. Phone/Fax

Practice location:
  • Phone: 619-786-2086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT122253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: