=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093106742
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBEKAH ESGUERRA MT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2015
-----------------------------------------------------
Last Update Date | 05/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1803 PARK CENTER DR STE 101
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32835-6216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-895-8278
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1803 PARK CENTER DR STE 101
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32835-6216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-895-8278
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 2932
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------