Healthcare Provider Details

I. General information

NPI: 1548795867
Provider Name (Legal Business Name): BENJAMIN A ESQUIVEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 W 21ST ST
SOUTH SIOUX CITY NE
68776-2652
US

IV. Provider business mailing address

917 W 21ST ST PO BOX 355
SOUTH SIOUX CITY NE
68776-2652
US

V. Phone/Fax

Practice location:
  • Phone: 402-494-3337
  • Fax:
Mailing address:
  • Phone: 402-494-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: