Healthcare Provider Details

I. General information

NPI: 1215661830
Provider Name (Legal Business Name): JERIKA JEWEL ESGUERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33105 TRABUCO DR
LAKE ELSINORE CA
92530-2404
US

IV. Provider business mailing address

33105 TRABUCO DR
LAKE ELSINORE CA
92530-2404
US

V. Phone/Fax

Practice location:
  • Phone: 310-713-7891
  • Fax:
Mailing address:
  • Phone: 310-713-7891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: