Healthcare Provider Details

I. General information

NPI: 1851351795
Provider Name (Legal Business Name): BEVERLY ESTES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 APPIAN WAY SUITE 100
PINOLE CA
94564-2524
US

IV. Provider business mailing address

11875 DUBLIN BLVD SUITE B 125
DUBLIN CA
94568-2843
US

V. Phone/Fax

Practice location:
  • Phone: 510-724-8300
  • Fax: 510-724-8391
Mailing address:
  • Phone: 925-587-2505
  • Fax: 925-587-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG19892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: