Provider Demographics
NPI:1134318793
Name:ESTELA DIESFELD MD PROF CORP
Entity Type:Organization
Organization Name:ESTELA DIESFELD MD PROF CORP
Other - Org Name:PAIN SPECIALTY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAGON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-644-4930
Mailing Address - Street 1:1752 S VICTORIA AVE
Mailing Address - Street 2:B
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-644-4930
Mailing Address - Fax:805-644-4960
Practice Address - Street 1:1752 S VICTORIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-644-4930
Practice Address - Fax:805-644-4960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50644208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19295Medicare PIN