Provider Demographics
NPI:1326660044
Name:MICHAEL, ESTELLA J
Entity Type:Individual
Prefix:
First Name:ESTELLA
Middle Name:J
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10730 CHURCH ST APT 368
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6659
Mailing Address - Country:US
Mailing Address - Phone:909-599-8222
Mailing Address - Fax:909-599-8223
Practice Address - Street 1:30 COUNTRY WOOD DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-4818
Practice Address - Country:US
Practice Address - Phone:909-599-8222
Practice Address - Fax:909-599-8223
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator