Healthcare Provider Details

I. General information

NPI: 1386154623
Provider Name (Legal Business Name): ELIZABETH ESQUIVEL MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2017
Last Update Date: 09/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2459 MISSION ST
SAN MARINO CA
91108-1635
US

IV. Provider business mailing address

2459 MISSION ST
SAN MARINO CA
91108-1635
US

V. Phone/Fax

Practice location:
  • Phone: 626-765-7274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number91145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: