Healthcare Provider Details

I. General information

NPI: 1245851369
Provider Name (Legal Business Name): AMANDA JEAN ESQUIBEL MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 S TELSHOR BLVD STE 301
LAS CRUCES NM
88011-4757
US

IV. Provider business mailing address

C/O BBP SERVICES LLC 1180 COMMERCE DR UNIT 13880
LAS CRUCES NM
88013-4636
US

V. Phone/Fax

Practice location:
  • Phone: 575-649-0073
  • Fax:
Mailing address:
  • Phone: 575-649-0073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT83980
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-1050
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: