Provider Demographics
NPI:1558560482
Name:ESTILO, GENEVIEVE (MD)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:ESTILO
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 1:1300 S ELISEO DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2023
Mailing Address - Country:US
Mailing Address - Phone:415-925-3075
Mailing Address - Fax:415-925-3070
Practice Address - Street 1:1300 S ELISEO DR
Practice Address - Street 2:SUITE 104
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2023
Practice Address - Country:US
Practice Address - Phone:415-925-3075
Practice Address - Fax:415-925-3070
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08275400207RN0300X
CAA111797207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY48896YMedicare PIN
NJ116807A4GMedicare PIN
CADE018ZMedicare PIN