Healthcare Provider Details

I. General information

NPI: 1295695278
Provider Name (Legal Business Name): ALEXIS GENEVIEVE ESQUIVEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 PORTOLA RD
VENTURA CA
93003-8046
US

IV. Provider business mailing address

16255 VENTURA BLVD STE 900
ENCINO CA
91436-2317
US

V. Phone/Fax

Practice location:
  • Phone: 858-649-5858
  • Fax:
Mailing address:
  • Phone: 858-264-5858
  • Fax: 858-264-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-489862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: