Healthcare Provider Details

I. General information

NPI: 1083419642
Provider Name (Legal Business Name): SUSANA ESQUIVEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 LOUETTA RD
SPRING TX
77388-4785
US

IV. Provider business mailing address

2525 LOUETTA RD
SPRING TX
77388-4785
US

V. Phone/Fax

Practice location:
  • Phone: 832-600-5517
  • Fax:
Mailing address:
  • Phone: 832-600-5517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-359007
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: