Provider Demographics
NPI:1245370584
Name:ESTEPA, PURUCA (MD)
Entity type:Individual
Prefix:DR
First Name:PURUCA
Middle Name:
Last Name:ESTEPA
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 1:3353 W VINE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4663
Mailing Address - Country:US
Mailing Address - Phone:407-931-3001
Mailing Address - Fax:407-931-3909
Practice Address - Street 1:3353 W VINE ST STE 101
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4663
Practice Address - Country:US
Practice Address - Phone:407-931-3001
Practice Address - Fax:407-931-3909
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME636952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF38669Medicare UPIN
FL17925Medicare ID - Type Unspecified