Healthcare Provider Details

I. General information

NPI: 1730463936
Provider Name (Legal Business Name): KAREN GRACE FRAN ESTEBAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15650 SAN PABLO AVE
SAN PABLO CA
94806-1240
US

IV. Provider business mailing address

15650 SAN PABLO AVE
SAN PABLO CA
94806-1240
US

V. Phone/Fax

Practice location:
  • Phone: 510-243-1100
  • Fax: 510-243-0527
Mailing address:
  • Phone: 510-243-1100
  • Fax: 510-243-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: