Provider Demographics
NPI:1154375798
Name:ESTANISLAO, LYDIA BORJAS (MD)
Entity type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:BORJAS
Last Name:ESTANISLAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4206 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1625
Mailing Address - Country:US
Mailing Address - Phone:702-331-6709
Mailing Address - Fax:888-624-0181
Practice Address - Street 1:4206 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1625
Practice Address - Country:US
Practice Address - Phone:702-331-6709
Practice Address - Fax:888-624-0181
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV111062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology