Healthcare Provider Details

I. General information

NPI: 1407568264
Provider Name (Legal Business Name): SARA ESQUIVEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2022
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 4TH ST NW
LOS RANCHOS NM
87107-5800
US

IV. Provider business mailing address

5705 ALEGRIA RD NW
ALBUQUERQUE NM
87114-4703
US

V. Phone/Fax

Practice location:
  • Phone: 505-433-7561
  • Fax:
Mailing address:
  • Phone: 505-903-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: