Healthcare Provider Details

I. General information

NPI: 1174275705
Provider Name (Legal Business Name): VINCENT ESQUIVEL JR. RADT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 W WALNUT AVE
VISALIA CA
93277-6232
US

IV. Provider business mailing address

3345 W CAMPUS AVE
VISALIA CA
93277-1890
US

V. Phone/Fax

Practice location:
  • Phone: 559-732-4885
  • Fax: 559-732-8289
Mailing address:
  • Phone: 559-602-5263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1403210820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: