Healthcare Provider Details

I. General information

NPI: 1104821032
Provider Name (Legal Business Name): ESTEVAN ACUNA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13975 MONO WAY SUITE G
SONORA CA
95370-2824
US

IV. Provider business mailing address

PO BOX 939
ANGELS CAMP CA
95222-0939
US

V. Phone/Fax

Practice location:
  • Phone: 209-533-9600
  • Fax: 209-533-9608
Mailing address:
  • Phone: 209-754-6262
  • Fax: 209-754-6274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number360218
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP360218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: