1710256250 NPI number — DR. PEDRO LUIS ESTACIO MD

Table of content: DR. PEDRO LUIS ESTACIO MD (NPI 1710256250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710256250 NPI number — DR. PEDRO LUIS ESTACIO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESTACIO
Provider First Name:
PEDRO
Provider Middle Name:
LUIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESTACIO
Provider Other First Name:
PETER
Provider Other Middle Name:
LUIS
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1710256250
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3333
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREMONT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94539-0333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-423-2367
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 EAST AVE
Provider Second Line Business Practice Location Address:
BUILDING 663 HSD
Provider Business Practice Location Address City Name:
LIVERMORE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94550-9698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-525-4523
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G068986 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)