Healthcare Provider Details

I. General information

NPI: 1619016987
Provider Name (Legal Business Name): LEONCIA ESQUIVEL CARLOTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 CROOKED HILL RD
W BRENTWOOD NY
11717-1043
US

IV. Provider business mailing address

105 WESTWOOD DR # 132
WESTBURY NY
11590-5540
US

V. Phone/Fax

Practice location:
  • Phone: 631-453-4628
  • Fax:
Mailing address:
  • Phone: 631-453-4628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number123037
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: