Provider Demographics
NPI:1730627621
Name:ESTEVEZ, CHRISTIAN (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:ESTEVEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5375 SW ORCHID BAY DR
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-8520
Mailing Address - Country:US
Mailing Address - Phone:772-708-7189
Mailing Address - Fax:
Practice Address - Street 1:3618 LANTANA RD STE 202
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-2247
Practice Address - Country:US
Practice Address - Phone:561-296-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110121363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65033OtherPA-C CONTROL NUMBER
FL00013286OtherPA-C PRESCRIBING NUMBER
FLPA9110121OtherPA-C LICENSE NUMBER