Provider Demographics
NPI:1821824392
Name:ESTEP, COLTON (IDC)
Entity type:Individual
Prefix:
First Name:COLTON
Middle Name:
Last Name:ESTEP
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 NICOLETTE AVE UNIT 1322
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3980
Mailing Address - Country:US
Mailing Address - Phone:740-550-3099
Mailing Address - Fax:
Practice Address - Street 1:1355 NICOLETTE AVE UNIT 1322
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-3980
Practice Address - Country:US
Practice Address - Phone:740-550-3099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Single Specialty