MEDICARE: MR. MARVIN ESGUERRA ANGELES P.T.

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	225100000X	Physical Therapist	PT 29388	CA

General Provider Information

NPI Number	:	1760747299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARVIN ESGUERRA ANGELES P.T.

Provider Business Mailing Address
First Line	:	3270 BENTON ST
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-3739
Country	:	US
Telephone Number	:	707-217-4388
Fax Number	:

Provider Business Practice Location Address
First Line	:	3270 BENTON ST
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-3739
Country	:	US
Telephone Number	:	707-217-4388
Fax Number	:

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

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	09/25/2019

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