Healthcare Provider Details

I. General information

NPI: 1346617206
Provider Name (Legal Business Name): KARLA VIANNEY ESQUIVEL VELAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13183 SAYRE ST
SYLMAR CA
91342-2535
US

IV. Provider business mailing address

13183 SAYRE ST
SYLMAR CA
91342-2535
US

V. Phone/Fax

Practice location:
  • Phone: 818-987-5188
  • Fax:
Mailing address:
  • Phone: 818-987-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number83161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: