Provider Demographics
NPI:1831120849
Name:ESTELA, CESAR A (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:A
Last Name:ESTELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9960 CAPE VERDE DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-6379
Mailing Address - Country:US
Mailing Address - Phone:702-274-2120
Mailing Address - Fax:
Practice Address - Street 1:9960 CAPE VERDE DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757
Practice Address - Country:US
Practice Address - Phone:702-274-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9610207RS0010X, 2081S0010X, 208100000X
CAC141462208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018625Medicaid
NV100530Medicare PIN
NVH31244Medicare UPIN
NV002018625Medicaid
NV102937Medicare PIN