Healthcare Provider Details

I. General information

NPI: 1750687034
Provider Name (Legal Business Name): GEORGINA ESQUIVEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9140 VAN NUYS BLVD STE 211
PANORAMA CITY CA
91402-6764
US

IV. Provider business mailing address

9140 VAN NUYS BLVD STE 211
PANORAMA CITY CA
91402-6764
US

V. Phone/Fax

Practice location:
  • Phone: 818-895-2206
  • Fax: 818-895-0824
Mailing address:
  • Phone: 818-895-2206
  • Fax: 818-895-0824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: