Basic Information
| Provider Information | |||||||||
| NPI: | 1952310898 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESQUER | ||||||||
| FirstName: | EDNA | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 516 WEST ATEN ROAD, SUITE 2 | ||||||||
| Address2: | |||||||||
| City: | IMPERIAL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603557730 | ||||||||
| FaxNumber: | 7603557731 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 E. U.S. HWY 98, SUITE 1 | ||||||||
| Address2: | |||||||||
| City: | CALEXICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608905593 | ||||||||
| FaxNumber: | 7605450251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 06/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 519676 | CA | N | Nursing Service Providers | Registered Nurse | 363L00000X | 13173 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | FHC18880F | 01 | MEDI-CAL | OTHER |