Provider Demographics
NPI:1215012406
Name:RACOMA, ESTELA OLIVA (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTELA
Middle Name:OLIVA
Last Name:RACOMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 ACOMA AVE
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-4737
Mailing Address - Country:US
Mailing Address - Phone:702-239-5836
Mailing Address - Fax:775-751-0405
Practice Address - Street 1:2620 ACOMA AVE
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4737
Practice Address - Country:US
Practice Address - Phone:775-751-0754
Practice Address - Fax:775-751-0405
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6554208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509170OtherMEDICAID
NV002019336Medicaid
ED62790Medicare UPIN