Healthcare Provider Details

I. General information

NPI: 1104653815
Provider Name (Legal Business Name): GLORIA T ESQUIVEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14534 GRAHAM AVE
VICTORVILLE CA
92394-6999
US

IV. Provider business mailing address

14534 GRAHAM AVE
VICTORVILLE CA
92394-6999
US

V. Phone/Fax

Practice location:
  • Phone: 323-316-5561
  • Fax:
Mailing address:
  • Phone: 323-316-5561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: