Healthcare Provider Details

I. General information

NPI: 1962876854
Provider Name (Legal Business Name): JENNIFER ESQUER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 WILSHIRE BLVD
SANTA MONICA CA
90403-2301
US

IV. Provider business mailing address

11840 RIVERSIDE DR APT 8
VALLEY VILLAGE CA
91607-4031
US

V. Phone/Fax

Practice location:
  • Phone: 310-264-8385
  • Fax:
Mailing address:
  • Phone: 909-636-9257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number43217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: