Healthcare Provider Details

I. General information

NPI: 1295172005
Provider Name (Legal Business Name): MARISSA W ESQUIVEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13911 ST FRANCIS BLVD STE 102
MIDLOTHIAN VA
23114-3256
US

IV. Provider business mailing address

13911 ST FRANCIS BLVD STE 102
MIDLOTHIAN VA
23114-3256
US

V. Phone/Fax

Practice location:
  • Phone: 804-709-3792
  • Fax: 804-825-9492
Mailing address:
  • Phone: 804-709-3792
  • Fax: 804-825-9492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116025751
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: