MEDICARE: MS. KRISTINA DIANNE ESQUIVEL LCSW, CPRP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101YM0800X	Mental Health Counselor	230456	CA
4	1041C0700X	Clinical Social Worker	126543	CA

General Provider Information

NPI Number	:	1568741270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTINA DIANNE ESQUIVEL LCSW, CPRP

Provider Business Mailing Address
First Line	:	PO BOX 603
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92842-0603
Country	:	US
Telephone Number	:	657-296-2584
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 603
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92842-0603
Country	:	US
Telephone Number	:	657-296-2584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2011
Last Update Date	:	10/21/2024

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