Provider Demographics
NPI:1477102291
Name:ESTACIO, LUDWIG
Entity Type:Individual
Prefix:
First Name:LUDWIG
Middle Name:
Last Name:ESTACIO
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 1:2208 W 8TH ST APT 327
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-5050
Mailing Address - Country:US
Mailing Address - Phone:909-344-8963
Mailing Address - Fax:
Practice Address - Street 1:3055 WILSHIRE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1147
Practice Address - Country:US
Practice Address - Phone:213-375-3830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker