Healthcare Provider Details

I. General information

NPI: 1417519323
Provider Name (Legal Business Name): KRISTEN ESQUIVEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNSER BLVD SE
RIO RANCHO NM
87124-4660
US

IV. Provider business mailing address

5620 RED RIVER RD NW
ALBUQUERQUE NM
87114-6094
US

V. Phone/Fax

Practice location:
  • Phone: 505-916-2007
  • Fax:
Mailing address:
  • Phone: 505-702-2323
  • 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: