Provider Demographics
NPI:1215661830
Name:ESGUERRA, JERIKA JEWEL
Entity type:Individual
Prefix:
First Name:JERIKA
Middle Name:JEWEL
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 1:33105 TRABUCO DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-2404
Mailing Address - Country:US
Mailing Address - Phone:310-713-7891
Mailing Address - Fax:
Practice Address - Street 1:33105 TRABUCO DR
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-2404
Practice Address - Country:US
Practice Address - Phone:310-713-7891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician