Healthcare Provider Details

I. General information

NPI: 1285945576
Provider Name (Legal Business Name): JETHRO JOHN V ESGUERRA RN, MSN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 12/14/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 ATLANTIC AVE STE 300
LONG BEACH CA
90807-2249
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 562-481-3500
  • Fax:
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: