Provider Demographics
NPI:1376302612
Name:ESTOMAGO, MICHAELA CHARLIZE ALIBIANO
Entity Type:Individual
Prefix:
First Name:MICHAELA CHARLIZE
Middle Name:ALIBIANO
Last Name:ESTOMAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8770 N THORNYDALE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-9096
Mailing Address - Country:US
Mailing Address - Phone:520-230-3178
Mailing Address - Fax:
Practice Address - Street 1:8770 N THORNYDALE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-9096
Practice Address - Country:US
Practice Address - Phone:520-230-3178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician