MEDICARE: MARY ELIZABETH ESTAKHRI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	G53902	CA

General Provider Information

NPI Number	:	1467579763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH ESTAKHRI MD

Provider Business Mailing Address
First Line	:	5565 W LAS POSITAS BLVD STE 260
Second Line	:
City	:	PLEASANTON
State	:	CA
Zip	:	94588-5807
Country	:	US
Telephone Number	:	925-534-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	5565 W LAS POSITAS BLVD STE 260
Second Line	:
City	:	PLEASANTON
State	:	CA
Zip	:	94588-5807
Country	:	US
Telephone Number	:	925-534-0500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	04/28/2024

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