Provider Demographics
NPI:1679520449
Name:OUANO, ESTELITA C (MD)
Entity type:Individual
Prefix:
First Name:ESTELITA
Middle Name:C
Last Name:OUANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2833
Mailing Address - Country:US
Mailing Address - Phone:908-231-0777
Mailing Address - Fax:908-722-6031
Practice Address - Street 1:350 GROVE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2833
Practice Address - Country:US
Practice Address - Phone:908-231-0777
Practice Address - Fax:908-722-6031
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA061943207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G16148Medicare UPIN
OU803944Medicare ID - Type Unspecified