Healthcare Provider Details

I. General information

NPI: 1437066602
Provider Name (Legal Business Name): ANTHONY DAVID ESQUIVEL IV BSN, RN, CCRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12427 STARDELL LN
YUCAIPA CA
92399-6427
US

IV. Provider business mailing address

12427 STARDELL LN
YUCAIPA CA
92399-6427
US

V. Phone/Fax

Practice location:
  • Phone: 714-397-7849
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95282414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: