Healthcare Provider Details

I. General information

NPI: 1699196667
Provider Name (Legal Business Name): MARCELA ESQUIVEL INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 PLEASANT HILL RD
KISSIMMEE FL
34746-3061
US

IV. Provider business mailing address

9011 TUSCAN VALLEY PL
ORLANDO FL
32825-7578
US

V. Phone/Fax

Practice location:
  • Phone: 407-846-0023
  • Fax:
Mailing address:
  • Phone: 321-626-2186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: