Provider Demographics
NPI:1992465058
Name:ESTIOKO, NICHOLAS PAULOS ZABLAN (PA-C)
Entity type:Individual
Prefix:
First Name:NICHOLAS PAULOS
Middle Name:ZABLAN
Last Name:ESTIOKO
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 1:130 IMPALA TRCE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4853
Mailing Address - Country:US
Mailing Address - Phone:619-569-6603
Mailing Address - Fax:
Practice Address - Street 1:23119 W INTERSTATE 10 BLDG 7
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1767
Practice Address - Country:US
Practice Address - Phone:210-994-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15115363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty