1821048083 NPI number — MS. JENNIFER L ESTRELLA N.P.

Table of content: MS. JENNIFER L ESTRELLA N.P. (NPI 1821048083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821048083 NPI number — MS. JENNIFER L ESTRELLA N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESTRELLA
Provider First Name:
JENNIFER
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
N.P.
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:
1821048083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11480 BROOKSHIRE AVE
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
DOWNEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90241-5010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-904-1651
Provider Business Mailing Address Fax Number:
562-904-1656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11480 BROOKSHIRE AVE
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
DOWNEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90241-5010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-904-1651
Provider Business Practice Location Address Fax Number:
562-904-1656
Provider Enumeration Date:
05/10/2006

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: 363L00000X , with the licence number:  RN305947 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GR0080690 . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ54573Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007364697 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0080690 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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