Provider Demographics
NPI:1205686268
Name:CLOSEDLOOPCLINIC
Entity type:Organization
Organization Name:CLOSEDLOOPCLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTIU SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-599-1117
Mailing Address - Street 1:160 W TYLER ST UNIT 679
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3956
Mailing Address - Country:US
Mailing Address - Phone:408-559-1117
Mailing Address - Fax:
Practice Address - Street 1:160 W TYLER ST UNIT 679
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-3956
Practice Address - Country:US
Practice Address - Phone:408-559-1117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty