Provider Demographics
NPI:1407376460
Name:ESQUIVEL, MARISA RAQUEL (DPT)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:RAQUEL
Last Name:ESQUIVEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 MONTGOMERY BLVD NE STE 302
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2467
Mailing Address - Country:US
Mailing Address - Phone:505-293-6262
Mailing Address - Fax:505-293-6622
Practice Address - Street 1:9201 MONTGOMERY BLVD NE STE 302
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2467
Practice Address - Country:US
Practice Address - Phone:505-293-6262
Practice Address - Fax:505-293-6622
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM17082251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053470187OtherFACILITY NPI