Provider Demographics
NPI:1326173618
Name:MARTINEZ, ESTELLA FAVIOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTELLA
Middle Name:FAVIOLA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 E 118TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-7314
Mailing Address - Country:US
Mailing Address - Phone:773-646-9800
Mailing Address - Fax:
Practice Address - Street 1:3550 E 118TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-7314
Practice Address - Country:US
Practice Address - Phone:773-646-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-117092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-117092OtherSTATE LICENSE