Provider Demographics
NPI:1902059629
Name:ESQUEDA, FABIAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:FABIAN
Middle Name:
Last Name:ESQUEDA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13307 SAN ANTONIO DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-2970
Mailing Address - Country:US
Mailing Address - Phone:562-863-0124
Mailing Address - Fax:562-868-6795
Practice Address - Street 1:13307 SAN ANTONIO DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2970
Practice Address - Country:US
Practice Address - Phone:562-863-0124
Practice Address - Fax:562-868-6795
Is Sole Proprietor?:No
Enumeration Date:2008-10-25
Last Update Date:2008-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15997363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant