Healthcare Provider Details

I. General information

NPI: 1750426573
Provider Name (Legal Business Name): DENISE MARIE ESQUIBEL-LEDESMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11741 TELEGRAPH RD
SANTA FE SPRINGS CA
90670-3681
US

IV. Provider business mailing address

14835 FERNVIEW ST
WHITTIER CA
90604-1929
US

V. Phone/Fax

Practice location:
  • Phone: 562-942-8256
  • Fax:
Mailing address:
  • Phone: 562-944-7891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT19317
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: