Provider Demographics
NPI:1295456481
Name:GREG ALAESTANTE DO PC
Entity type:Organization
Organization Name:GREG ALAESTANTE DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:B
Authorized Official - Last Name:ALAESTATE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-326-8348
Mailing Address - Street 1:2204 S DOBSON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6457
Mailing Address - Country:US
Mailing Address - Phone:480-912-3510
Mailing Address - Fax:480-912-3514
Practice Address - Street 1:2204 S DOBSON RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6457
Practice Address - Country:US
Practice Address - Phone:480-912-3510
Practice Address - Fax:480-912-3514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty