Provider Demographics
NPI:1164974580
Name:CADDALI, ESTRELLA
Entity Type:Individual
Prefix:
First Name:ESTRELLA
Middle Name:
Last Name:CADDALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ESTRELLA
Other - Middle Name:
Other - Last Name:CADDALI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:41 MONTEBELLO RD STE 204
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1379
Mailing Address - Country:US
Mailing Address - Phone:719-545-2746
Mailing Address - Fax:719-545-4100
Practice Address - Street 1:41 MONTEBELLO RD STE 116
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001
Practice Address - Country:US
Practice Address - Phone:719-423-1500
Practice Address - Fax:719-542-9269
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992681-NP363LF0000X, 363L00000X, 363LP0808X
CORN.0204683163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAPN.0992681-NPOtherCOLORADO MEDICAL LICENSE