Healthcare Provider Details

I. General information

NPI: 1659678712
Provider Name (Legal Business Name): JAVIER ESQUIVEL-ACOSTA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 S WHITE RD SUITE 95
SAN JOSE CA
95148-2076
US

IV. Provider business mailing address

2690 S WHITE RD SUITE 95
SAN JOSE CA
95148-2076
US

V. Phone/Fax

Practice location:
  • Phone: 408-223-8080
  • Fax: 408-223-8088
Mailing address:
  • Phone: 408-223-8080
  • Fax: 408-223-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1091854
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: