Provider Demographics
NPI:1033430681
Name:ESQUIVEL, MONICA (RD)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:ESQUIVEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:KAZLAUSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:217 WILDEMERE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-3124
Mailing Address - Country:US
Mailing Address - Phone:571-276-5569
Mailing Address - Fax:
Practice Address - Street 1:1915 LAKE AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-9366
Practice Address - Country:US
Practice Address - Phone:574-936-3181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA995814133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered