Healthcare Provider Details

I. General information

NPI: 1164666715
Provider Name (Legal Business Name): MICHAEL CHRISTOPHER ESTES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-8358
US

IV. Provider business mailing address

2020 SANTA MONICA BLVD STE. 210
SANTA MONICA CA
90404-2023
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-8307
  • Fax: 310-260-2963
Mailing address:
  • Phone: 310-458-2381
  • Fax: 310-260-2963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA113850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: