Provider Demographics
NPI:1245851369
Name:ESQUIBEL, AMANDA JEAN (MS, RD, LD)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:JEAN
Last Name:ESQUIBEL
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C/O BBP SERVICES LLC
Mailing Address - Street 2:1180 COMMERCE DR UNIT 13880
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88013-4636
Mailing Address - Country:US
Mailing Address - Phone:575-649-0073
Mailing Address - Fax:
Practice Address - Street 1:1155 S TELSHOR BLVD STE 301
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4757
Practice Address - Country:US
Practice Address - Phone:575-649-0073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83980133V00000X
NMLD-1050133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered