Healthcare Provider Details

I. General information

NPI: 1356303655
Provider Name (Legal Business Name): JULIO ESQUILIN IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 USS MARIANO G. VALLEJO AVENUE
KINGS BAY GA
31547-2626
US

IV. Provider business mailing address

95138 WOODBRIDGE PKWY #208
FERNANDINA BEACH FL
32034-8755
US

V. Phone/Fax

Practice location:
  • Phone: 912-573-2939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: