Provider Demographics
NPI:1538347216
Name:ESTEBAN AMBRAD-CHALELA,MD,PLLC
Entity type:Organization
Organization Name:ESTEBAN AMBRAD-CHALELA,MD,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VASCULAR SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:ESTEBAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBRAD-CHALELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-946-9707
Mailing Address - Street 1:761 WILLIAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354
Mailing Address - Country:US
Mailing Address - Phone:509-946-9707
Mailing Address - Fax:509-946-8145
Practice Address - Street 1:761 WILLIAMS BLVD.
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354
Practice Address - Country:US
Practice Address - Phone:509-946-9707
Practice Address - Fax:509-946-8145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000391982086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1124833Medicaid
WAG97329Medicare UPIN
WAG8871218Medicare PIN