Provider Demographics
NPI:1477894632
Name:ESTRELLA, JR
Entity Type:Individual
Prefix:
First Name:JR
Middle Name:
Last Name:ESTRELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-3022
Mailing Address - Country:US
Mailing Address - Phone:714-686-6031
Mailing Address - Fax:714-526-0411
Practice Address - Street 1:801 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-3022
Practice Address - Country:US
Practice Address - Phone:714-686-6031
Practice Address - Fax:714-526-0411
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health