Healthcare Provider Details

I. General information

NPI: 1952870115
Provider Name (Legal Business Name): CHRISTIE ESQUIVEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTIE SAKATA PA-C

II. Dates (important events)

Enumeration Date: 11/17/2018
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 E CAROLINE ST STE 1400
SAN BERNARDINO CA
92408-3731
US

IV. Provider business mailing address

197 E CAROLINE ST STE 1400
SAN BERNARDINO CA
92408-3731
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-3636
  • Fax:
Mailing address:
  • Phone: 909-558-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number58435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: