Healthcare Provider Details

I. General information

NPI: 1295068609
Provider Name (Legal Business Name): JOSE LUIS ESQUEDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3742 LOCUST AVE
LONG BEACH CA
90807-3308
US

IV. Provider business mailing address

3742 LOCUST AVE
LONG BEACH CA
90807-3308
US

V. Phone/Fax

Practice location:
  • Phone: 213-342-0100
  • Fax: 213-342-0200
Mailing address:
  • Phone: 213-342-0100
  • Fax: 213-342-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number86028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: