Healthcare Provider Details

I. General information

NPI: 1174166714
Provider Name (Legal Business Name): KIMBERLY ERIN ESGATE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN ESGATE PA

II. Dates (important events)

Enumeration Date: 10/27/2019
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 E WILBUR RD STE 100
THOUSAND OAKS CA
91360-7925
US

IV. Provider business mailing address

1970 RORY LN UNIT 2
SIMI VALLEY CA
93063-4388
US

V. Phone/Fax

Practice location:
  • Phone: 805-492-1015
  • Fax: 805-492-2035
Mailing address:
  • Phone: 805-875-7883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA58862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: