Provider Demographics
NPI:1013507177
Name:NOA ESQUIVEL, DORIS E
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:E
Last Name:NOA ESQUIVEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 W 68TH ST APT 7
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5138
Mailing Address - Country:US
Mailing Address - Phone:786-440-1728
Mailing Address - Fax:
Practice Address - Street 1:8100 NW 155TH ST STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5865
Practice Address - Country:US
Practice Address - Phone:786-440-1728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-143205106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty