Provider Demographics
NPI:1215366570
Name:ESQUIVEL, MARIO (PA)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:ESQUIVEL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1530 W 6TH ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2742
Mailing Address - Country:US
Mailing Address - Phone:951-279-2171
Mailing Address - Fax:951-279-4514
Practice Address - Street 1:1530 W 6TH ST
Practice Address - Street 2:SUITE 109
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2742
Practice Address - Country:US
Practice Address - Phone:951-279-2171
Practice Address - Fax:951-279-4514
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA51223363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical