Provider Demographics
NPI:1588977243
Name:ESTOPINAN, LISANI PATRICIA (MD)
Entity type:Individual
Prefix:DR
First Name:LISANI
Middle Name:PATRICIA
Last Name:ESTOPINAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:520 MEDICAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8925
Mailing Address - Country:US
Mailing Address - Phone:801-292-1422
Mailing Address - Fax:801-296-0436
Practice Address - Street 1:520 MEDICAL DR STE 300
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8925
Practice Address - Country:US
Practice Address - Phone:801-292-1422
Practice Address - Fax:801-296-0436
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT10750100-1205207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist