Healthcare Provider Details

I. General information

NPI: 1467720177
Provider Name (Legal Business Name): OMAR ESQUIVEL MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 47TH AVE SUITE 111
SACRAMENTO CA
95824-3923
US

IV. Provider business mailing address

1903 2ND AVE
SACRAMENTO CA
95818-3156
US

V. Phone/Fax

Practice location:
  • Phone: 916-393-1222
  • Fax:
Mailing address:
  • Phone: 408-509-8922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: