Healthcare Provider Details

I. General information

NPI: 1093106742
Provider Name (Legal Business Name): REBEKAH ESGUERRA MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 PARK CENTER DR STE 101
ORLANDO FL
32835-6216
US

IV. Provider business mailing address

1803 PARK CENTER DR STE 101
ORLANDO FL
32835-6216
US

V. Phone/Fax

Practice location:
  • Phone: 813-895-8278
  • Fax:
Mailing address:
  • Phone: 813-895-8278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2932
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: