Healthcare Provider Details

I. General information

NPI: 1750318275
Provider Name (Legal Business Name): CHRISTY L ESKES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 S K ST
SAN BERNARDINO CA
92410-2641
US

IV. Provider business mailing address

1454 E 2ND ST
SAN BERNARDINO CA
92408-0118
US

V. Phone/Fax

Practice location:
  • Phone: 909-383-8092
  • Fax:
Mailing address:
  • Phone: 909-382-7146
  • Fax: 909-382-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17106
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: