Provider Demographics
NPI:1750451159
Name:ESQUEDA, NICOLE DEAN (OD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DEAN
Last Name:ESQUEDA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N IRWIN ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-4537
Mailing Address - Country:US
Mailing Address - Phone:559-584-4227
Mailing Address - Fax:559-584-4785
Practice Address - Street 1:115 N IRWIN ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4537
Practice Address - Country:US
Practice Address - Phone:559-584-4227
Practice Address - Fax:559-584-4785
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12569T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD 0125690Medicaid
CAV 01251Medicare UPIN
CASD 0125691Medicare ID - Type Unspecified