Healthcare Provider Details

I. General information

NPI: 1659138790
Provider Name (Legal Business Name): RONETTE LINDA ESQUEDA CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 LUNDY AVE STE 223
SAN JOSE CA
95131-1888
US

IV. Provider business mailing address

1885 LUNDY AVE STE 223
SAN JOSE CA
95131-1888
US

V. Phone/Fax

Practice location:
  • Phone: 408-284-9000
  • Fax:
Mailing address:
  • Phone: 408-284-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-KBUFRA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: