Provider Demographics
NPI:1003807595
Name:ESTES, CRAIG N (PA)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:N
Last Name:ESTES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41120 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-9215
Mailing Address - Country:US
Mailing Address - Phone:760-360-3193
Mailing Address - Fax:760-320-2725
Practice Address - Street 1:41120 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-9215
Practice Address - Country:US
Practice Address - Phone:760-360-3193
Practice Address - Fax:760-320-2725
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16866363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP87275Medicare UPIN
CA0PA168660Medicare ID - Type Unspecified