Healthcare Provider Details

I. General information

NPI: 1699133207
Provider Name (Legal Business Name): KARLA ESQUIVEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 HIGH ST
SAN LUIS OBISPO CA
93401-5243
US

IV. Provider business mailing address

PO BOX 15408
SAN LUIS OBISPO CA
93406-5408
US

V. Phone/Fax

Practice location:
  • Phone: 805-540-6500
  • Fax: 805-540-6501
Mailing address:
  • Phone: 805-540-6500
  • Fax: 805-540-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number632200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: