Healthcare Provider Details

I. General information

NPI: 1821824392
Provider Name (Legal Business Name): COLTON ESTEP IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 NICOLETTE AVE UNIT 1322
CHULA VISTA CA
91913-3980
US

IV. Provider business mailing address

1355 NICOLETTE AVE UNIT 1322
CHULA VISTA CA
91913-3980
US

V. Phone/Fax

Practice location:
  • Phone: 740-550-3099
  • Fax:
Mailing address:
  • Phone: 740-550-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: