=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528885340
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | INDIA ESGUERRA MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2024
-----------------------------------------------------
Last Update Date | 09/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2660 CYPRESS RIDGE BLVD STE 101
-----------------------------------------------------
City | WESLEY CHAPEL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33544-6324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-994-4440
-----------------------------------------------------
Fax | 813-973-1254
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11063 LITTLE BLUE HERON DR
-----------------------------------------------------
City | RIVERVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33579-2419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-322-6613
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------