Healthcare Provider Details

I. General information

NPI: 1033430681
Provider Name (Legal Business Name): MONICA ESQUIVEL R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA KAZLAUSKY R.D.

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 LAKE AVE
PLYMOUTH IN
46563-9366
US

IV. Provider business mailing address

217 WILDEMERE DR
SOUTH BEND IN
46615-3124
US

V. Phone/Fax

Practice location:
  • Phone: 574-936-3181
  • Fax:
Mailing address:
  • Phone: 571-276-5569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number995814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: