Healthcare Provider Details

I. General information

NPI: 1194858258
Provider Name (Legal Business Name): MS. WENDY ESQUEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 DALY ST
LOS ANGELES CA
90031-2230
US

IV. Provider business mailing address

2309 DALY ST
LOS ANGELES CA
90031-2230
US

V. Phone/Fax

Practice location:
  • Phone: 323-222-4591
  • Fax: 323-222-4614
Mailing address:
  • Phone: 323-222-4591
  • Fax: 323-222-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: