Healthcare Provider Details

I. General information

NPI: 1992340244
Provider Name (Legal Business Name): JUDY ANNETTE ESQUEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 LOMITA BLVD STE 427
TORRANCE CA
90505-4896
US

IV. Provider business mailing address

7553 NIAGARA DR
FONTANA CA
92336-1731
US

V. Phone/Fax

Practice location:
  • Phone: 310-325-9400
  • Fax:
Mailing address:
  • Phone: 626-422-5937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: