1811152481 NPI number — DR. EDUARDO F. ESTELLA, PSC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811152481 NPI number — DR. EDUARDO F. ESTELLA, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. EDUARDO F. ESTELLA, PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1811152481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AVE ORTEGON # 107
Provider Second Line Business Mailing Address:
CAPARRA GALLERY SUITE 212
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00966-2508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-707-0059
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PMB 254 1353
Provider Second Line Business Practice Location Address:
RD 19
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-707-0059
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ESTRELLA
Authorized Official First Name:
EDUARDO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-707-0059

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  14164 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 14164 . This is a "PUERTO RICO MEDICAL BOARD" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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