Provider Demographics
NPI:1023202371
Name:RHODA ESTRELLA-ITCHON, M.D., INC.
Entity Type:Organization
Organization Name:RHODA ESTRELLA-ITCHON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RHODA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRELLA-ITCHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-461-1070
Mailing Address - Street 1:25495 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4902
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25495 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 301
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4902
Practice Address - Country:US
Practice Address - Phone:951-461-1070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55570207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6723134Medicaid
G44336Medicare UPIN