Healthcare Provider Details

I. General information

NPI: 1992686505
Provider Name (Legal Business Name): ESMERALDA JANETH HUIZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 HILLWIND RD NE STE 300
FRIDLEY MN
55432-5965
US

IV. Provider business mailing address

941 HILLWIND RD NE STE 300
FRIDLEY MN
55432-5965
US

V. Phone/Fax

Practice location:
  • Phone: 612-412-3318
  • Fax: 612-288-1805
Mailing address:
  • Phone: 612-412-3318
  • Fax: 612-288-1805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: