Healthcare Provider Details

I. General information

NPI: 1437827078
Provider Name (Legal Business Name): CRYSTAL ESQUIBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 E FRUIT ST
SANTA ANA CA
92701-4206
US

IV. Provider business mailing address

1317 S TOWNER ST
SANTA ANA CA
92707-1522
US

V. Phone/Fax

Practice location:
  • Phone: 949-396-4566
  • Fax:
Mailing address:
  • Phone: 714-418-3372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1449221121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: