Healthcare Provider Details

I. General information

NPI: 1548763212
Provider Name (Legal Business Name): BRYANNA RENEE ESQUIVEL DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 E TASMAN DR
SAN JOSE CA
95134-1617
US

IV. Provider business mailing address

90 E TASMAN DR
SAN JOSE CA
95134-1617
US

V. Phone/Fax

Practice location:
  • Phone: 408-944-6100
  • Fax: 408-944-6102
Mailing address:
  • Phone: 408-944-6100
  • Fax: 408-944-6102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34151
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number25502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: