Basic Information
Provider Information
NPI: 1982627675
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABORDO
FirstName: JOHN
MiddleName: ESTAMO
NamePrefix: DR.
NameSuffix:  
Credential: DPM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 737 W CHILDS AVE
Address2:  
City: MERCED
State: CA
PostalCode: 953416805
CountryCode: US
TelephoneNumber: 2093831848
FaxNumber: 2093831296
Practice Location
Address1: 857 W CHILDS AVE
Address2:  
City: MERCED
State: CA
PostalCode: 953416862
CountryCode: US
TelephoneNumber: 8666824842
FaxNumber: 2093836198
Other Information
ProviderEnumerationDate: 07/25/2006
LastUpdateDate: 10/21/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/21/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
213ES0103XE4625CAY Podiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery

No ID Information.


Home