Provider Demographics
NPI:1346617206
Name:ESQUIVEL VELAZQUEZ, KARLA VIANNEY
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:VIANNEY
Last Name:ESQUIVEL VELAZQUEZ
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 1:13183 SAYRE ST
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-2535
Mailing Address - Country:US
Mailing Address - Phone:818-987-5188
Mailing Address - Fax:
Practice Address - Street 1:13183 SAYRE ST
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-2535
Practice Address - Country:US
Practice Address - Phone:818-987-5188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83161126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant