Provider Demographics
NPI:1073175873
Name:ESTRONICK, LORRAINE MARGARET (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:MARGARET
Last Name:ESTRONICK
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:MARGARET
Other - Last Name:VASHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1138 9TH ST APT D
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5209
Mailing Address - Country:US
Mailing Address - Phone:805-428-0971
Mailing Address - Fax:
Practice Address - Street 1:15031 RINALDI ST
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1207
Practice Address - Country:US
Practice Address - Phone:818-365-8051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012061363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care