Healthcare Provider Details

I. General information

NPI: 1073711354
Provider Name (Legal Business Name): CARRIE ESKAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARRIE COTTERMAN

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12202 1ST ST
YUCAIPA CA
92399-4358
US

IV. Provider business mailing address

12447 15TH ST
YUCAIPA CA
92399-1785
US

V. Phone/Fax

Practice location:
  • Phone: 909-556-5842
  • Fax:
Mailing address:
  • Phone: 909-795-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: