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General NPI Number Information
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NPI Number | 1366038465
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Entity Type | Individual
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Provider Name | ERNEST CONSTANTINE ESTEBAN
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Gender | Male
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Dates
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Enumeration Date | 12/14/2020
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Last Update Date | 12/14/2020
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Provider Practice Location Address
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Address Line | 5235 S KYRENE RD STE 105-264
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City | TEMPE
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State | AZ
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Zip | 85283-1779
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Country | US
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Telephone | 480-466-7473
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Fax |
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Provider Business Mailing Address
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Address Line | 925 W BASELINE RD STE 105-264
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City | TEMPE
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State | AZ
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Zip | 85283-1100
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Country | US
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Telephone | 623-203-9737
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Fax | 480-945-5339
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 000134
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License Number State | AZ
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