Provider Demographics
NPI:1376652909
Name:DIESFELD, ESTELA (MD)
Entity Type:Individual
Prefix:
First Name:ESTELA
Middle Name:
Last Name:DIESFELD
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 1:1752 S VICTORIA AVE
Mailing Address - Street 2:SUITE 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
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50644208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G506441OtherBLUE SHIELD
CA00G506441OtherBLUE SHIELD
WG50644DMedicare PIN