Healthcare Provider Details

I. General information

NPI: 1336958867
Provider Name (Legal Business Name): ESMERALDA VENCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5603 S CENTRAL AVE
LOS ANGELES CA
90011-5967
US

IV. Provider business mailing address

4601 S BROADWAY
LOS ANGELES CA
90037-2729
US

V. Phone/Fax

Practice location:
  • Phone: 323-234-4445
  • Fax: 323-682-0632
Mailing address:
  • Phone: 323-234-4445
  • Fax: 323-682-0632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: