Basic Information
Provider Information
NPI: 1720631641
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ESQUIBEL
FirstName: PERRY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 41 MONTEBELLO RD STE 204
Address2:  
City: PUEBLO
State: CO
PostalCode: 810011379
CountryCode: US
TelephoneNumber: 7195452746
FaxNumber: 7195454100
Practice Location
Address1: 1302 CHINOOK LN
Address2:  
City: PUEBLO
State: CO
PostalCode: 810011851
CountryCode: US
TelephoneNumber: 7195452746
FaxNumber: 7195454100
Other Information
ProviderEnumerationDate: 07/19/2019
LastUpdateDate: 07/19/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN.0164759COY Nursing Service ProvidersRegistered Nurse 

No ID Information.


Home