Healthcare Provider Details

I. General information

NPI: 1629724273
Provider Name (Legal Business Name): LIZ ESQUIVEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15291 NW 60TH AVE STE 101
MIAMI LAKES FL
33014-2459
US

IV. Provider business mailing address

651 W 43RD PL
HIALEAH FL
33012-3852
US

V. Phone/Fax

Practice location:
  • Phone: 305-705-7702
  • Fax:
Mailing address:
  • Phone: 786-405-5664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: