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General NPI Number Information
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NPI Number | 1710258744
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Entity Type | Individual
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Provider Name | MAMERTO AGCAOILI ESTEPA JR. D.C.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2012
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Last Update Date | 08/14/2013
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Provider Practice Location Address
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Address Line | 1452 UNIVERSITY AVE
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City | SAN DIEGO
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State | CA
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Zip | 92103-3405
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Country | US
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Telephone | 619-291-5433
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Fax | 919-209-3608
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Provider Business Mailing Address
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Address Line | 1286 UNIVERSITY AVE # 545
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City | SAN DIEGO
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State | CA
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Zip | 92103-3312
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Country | US
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Telephone | 760-456-9086
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Fax | 760-456-9086
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC32131
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License Number State | CA
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