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General NPI Number Information
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NPI Number | 1265541353
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Entity Type | Individual
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Provider Name | MR. JAN REY G. ESTEBAN
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 22419 KENT AVE
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City | TORRANCE
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State | CA
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Zip | 90505-2303
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Country | US
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Telephone | 310-373-9774
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Fax |
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Provider Business Mailing Address
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Address Line | 105 CIMARRON ST
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City | LA PUENTE
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State | CA
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Zip | 91744-6202
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Country | US
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Telephone | 818-642-6818
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT32716
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License Number State | CA
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