Provider Demographics
NPI:1639930373
Name:CU, DOLORES ESTACIO
Entity Type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:ESTACIO
Last Name:CU
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 1:9788 CLAREWOOD DR STE 206
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3482
Mailing Address - Country:US
Mailing Address - Phone:713-777-1991
Mailing Address - Fax:713-777-1980
Practice Address - Street 1:9788 CLAREWOOD DR STE 206
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3482
Practice Address - Country:US
Practice Address - Phone:713-777-1991
Practice Address - Fax:713-777-1980
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016349372500000X, 376J00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001025442Medicaid