Healthcare Provider Details

I. General information

NPI: 1851942759
Provider Name (Legal Business Name): CHRISTINE LO BUE-ESTES PH.D., ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 BROADMOOR WAY
CARMICHAEL CA
95608-3423
US

IV. Provider business mailing address

3501 BROADMOOR WAY
CARMICHAEL CA
95608-3423
US

V. Phone/Fax

Practice location:
  • Phone: 716-390-0368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: