Provider Demographics
NPI:1154128478
Name:ESTACIO, BLAKE-LEE REECE
Entity type:Individual
Prefix:
First Name:BLAKE-LEE
Middle Name:REECE
Last Name:ESTACIO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 N NIMITZ HWY RM C210
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6514
Mailing Address - Country:US
Mailing Address - Phone:808-838-7752
Mailing Address - Fax:
Practice Address - Street 1:1130 N NIMITZ HWY RM C210
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6514
Practice Address - Country:US
Practice Address - Phone:808-838-7752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist