Healthcare Provider Details

I. General information

NPI: 1235876905
Provider Name (Legal Business Name): VENUS ESQUIVEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2499 E LAKESHORE DR
LAKE ELSINORE CA
92530-4411
US

IV. Provider business mailing address

2499 E LAKESHORE DR
LAKE ELSINORE CA
92530-4411
US

V. Phone/Fax

Practice location:
  • Phone: 951-471-4200
  • Fax:
Mailing address:
  • Phone: 951-471-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA197515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: