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General NPI Number Information
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NPI Number | 1730427014
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Entity Type | Individual
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Provider Name | DAVID COLLADO ESTABILLO FNP
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Gender | Male
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Dates
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Enumeration Date | 01/22/2013
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Last Update Date | 05/30/2018
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Provider Practice Location Address
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Address Line | 2000 W 21ST ST STE E3
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City | CLOVIS
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State | NM
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Zip | 88101
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Country | US
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Telephone | 954-655-3570
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1161
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City | CLOVIS
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State | NM
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Zip | 88102-1161
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Country | US
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Telephone | 954-655-3570
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 264709
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN-18171
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP-02364
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License Number State | NM
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