Provider Demographics
NPI:1336637727
Name:DAVID ESTABILLO LLC
Entity Type:Organization
Organization Name:DAVID ESTABILLO LLC
Other - Org Name:ADVANCED PRACTICE HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTABILLO
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:954-655-3570
Mailing Address - Street 1:PO BOX 1161
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88102-1161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 W 21ST ST STE E3
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4093
Practice Address - Country:US
Practice Address - Phone:954-655-3570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty