Provider Demographics
NPI:1770514655
Name:ESQUILLO, RUNDA D (PT)
Entity type:Individual
Prefix:MS
First Name:RUNDA
Middle Name:D
Last Name:ESQUILLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 MIRAMAR ST
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-7840
Mailing Address - Country:US
Mailing Address - Phone:805-558-7719
Mailing Address - Fax:805-388-1971
Practice Address - Street 1:145 MIRAMAR ST
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-7840
Practice Address - Country:US
Practice Address - Phone:805-558-7719
Practice Address - Fax:805-388-1971
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 14474174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist