Provider Demographics
NPI:1235721499
Name:MEDINA-ONTIVEROS, ESTELA MARISA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ESTELA
Middle Name:MARISA
Last Name:MEDINA-ONTIVEROS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 LOMALAND DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-4202
Mailing Address - Country:US
Mailing Address - Phone:915-595-0409
Mailing Address - Fax:915-595-3997
Practice Address - Street 1:1576 LOMALAND DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4202
Practice Address - Country:US
Practice Address - Phone:915-595-0409
Practice Address - Fax:915-595-3997
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist