Healthcare Provider Details

I. General information

NPI: 1427689454
Provider Name (Legal Business Name): MS. ERICA ESQUIVEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

87 I 10 N SUITE 225
BEAUMONT TX
77707
US

IV. Provider business mailing address

1450 N MAJOR DR APT 815
BEAUMONT TX
77706-4077
US

V. Phone/Fax

Practice location:
  • Phone: 409-835-0228
  • Fax: 409-835-0151
Mailing address:
  • Phone: 903-969-0452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number215897
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: