Provider Demographics
NPI:1417198938
Name:ESTUPINAN, IRVING
Entity Type:Individual
Prefix:MR
First Name:IRVING
Middle Name:
Last Name:ESTUPINAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 GEER RD
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2408
Mailing Address - Country:US
Mailing Address - Phone:209-669-6339
Mailing Address - Fax:209-669-6338
Practice Address - Street 1:2303 GEER RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2408
Practice Address - Country:US
Practice Address - Phone:209-669-6339
Practice Address - Fax:209-669-6338
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35501225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist