1659266674 NPI number — KISBEL ALEXANDRA PENA ESTRELLA

Table of content: KISBEL ALEXANDRA PENA ESTRELLA (NPI 1659266674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659266674 NPI number — KISBEL ALEXANDRA PENA ESTRELLA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENA ESTRELLA
Provider First Name:
KISBEL
Provider Middle Name:
ALEXANDRA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659266674
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 W, HOSPITAL ROAD POST OFFICE BOX 1020
Provider Second Line Business Mailing Address:
GRADUATE MEDICAL EDUCATION OFFICE SAN JOAQUIN GENERAL
Provider Business Mailing Address City Name:
FRENCH CAMP
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-468-6924
Provider Business Mailing Address Fax Number:
209-468-6924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 WEST HOSPITAL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRENCH CAMP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-468-6924
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com