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General NPI Number Information
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NPI Number | 1710256250
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Entity Type | Individual
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Provider Name | PEDRO LUIS ESTACIO MD
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Gender | Male
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Dates
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Enumeration Date | 12/28/2011
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Last Update Date | 12/28/2011
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Provider Practice Location Address
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Address Line | 7000 EAST AVE BUILDING 663 HSD
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City | LIVERMORE
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State | CA
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Zip | 94550-9698
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Country | US
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Telephone | 925-525-4523
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3333
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City | FREMONT
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State | CA
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Zip | 94539-0333
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Country | US
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Telephone | 925-423-2367
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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 | G068986
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License Number State | CA
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