Provider Demographics
NPI:1255534467
Name:ESTAPE, ESTELA (MT, PHD, FASAHP)
Entity type:Individual
Prefix:
First Name:ESTELA
Middle Name:
Last Name:ESTAPE
Suffix:
Gender:F
Credentials:MT, PHD, FASAHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 AVE RIO HONDO PMB 369
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3105
Mailing Address - Country:US
Mailing Address - Phone:787-378-1538
Mailing Address - Fax:787-764-1760
Practice Address - Street 1:90 AVE RIO HONDO PMB 369
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3105
Practice Address - Country:US
Practice Address - Phone:787-378-1538
Practice Address - Fax:787-764-1760
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1601246QC1000X
PR1069246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered246QC1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyChemistry
Not Answered246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1601OtherCHEMIST LICENSE
WA079613OtherASCP LICENSE
PR1069OtherMED. TECHNOLOGY LICENSE