Provider Demographics
NPI:1093389561
Name:VERDUGO, ESTELLA NICOLE
Entity Type:Individual
Prefix:
First Name:ESTELLA
Middle Name:NICOLE
Last Name:VERDUGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ESTELLA
Other - Middle Name:NICOLE
Other - Last Name:VERDUGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1040 N PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-2434
Mailing Address - Country:US
Mailing Address - Phone:559-899-0888
Mailing Address - Fax:
Practice Address - Street 1:1040 N PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-2434
Practice Address - Country:US
Practice Address - Phone:559-899-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist