Provider Demographics
NPI:1811488141
Name:ESGUERRA, JILLIAN VIDAL
Entity type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:VIDAL
Last Name:ESGUERRA
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 1:6316 HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-1824
Mailing Address - Country:US
Mailing Address - Phone:323-583-5887
Mailing Address - Fax:323-583-6601
Practice Address - Street 1:6316 HOLMES AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-1824
Practice Address - Country:US
Practice Address - Phone:323-583-5887
Practice Address - Fax:323-583-6601
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009108363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95009108Medicaid