Healthcare Provider Details

I. General information

NPI: 1194334284
Provider Name (Legal Business Name): ROBERT ESQUIVEL CERTIFIED COUNSELOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9705 HOLMES AVE
LOS ANGELES CA
90002-3031
US

IV. Provider business mailing address

9705 HOLMES AVE
LOS ANGELES CA
90002-3031
US

V. Phone/Fax

Practice location:
  • Phone: 323-249-9097
  • Fax: 323-249-9121
Mailing address:
  • Phone: 323-249-9097
  • Fax: 323-249-9121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC035800915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: