Provider Demographics
NPI:1033181045
Name:ESTABAYA, ELI R (MD)
Entity Type:Individual
Prefix:DR
First Name:ELI
Middle Name:R
Last Name:ESTABAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10835 N 25TH AVE
Mailing Address - Street 2:STE 240
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-3458
Mailing Address - Country:US
Mailing Address - Phone:602-943-9200
Mailing Address - Fax:602-216-3000
Practice Address - Street 1:19829 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4001
Practice Address - Country:US
Practice Address - Phone:623-879-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ127382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0221810OtherBLUE CROSS BLUE SHIELD AZ
AZ1Z7086OtherHEALTH NET OF ARIZONA
AZZ235392Medicare UPIN
AZZ30WCHLZ1EMedicare PIN
AZZ300038823Medicare PIN
AZ77521Medicare UPIN
AZZ77519Medicare PIN
AZAZ0221810OtherBLUE CROSS BLUE SHIELD AZ
AZ1Z7086OtherHEALTH NET OF ARIZONA
AZZ121139Medicare PIN
B97192Medicare UPIN