Provider Demographics
NPI:1497863252
Name:ESTRUCH, STELLA M (MD)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:M
Last Name:ESTRUCH
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1065 NE 125TH STREET
Mailing Address - Street 2:SUITE 409
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5834
Mailing Address - Country:US
Mailing Address - Phone:888-852-6672
Mailing Address - Fax:877-720-0502
Practice Address - Street 1:7481 W OAKLAND PARK BOULEVARD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4985
Practice Address - Country:US
Practice Address - Phone:954-771-7743
Practice Address - Fax:954-771-7748
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2017-05-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 946022084P0804X
FLME946022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001595700Medicaid
FLCW985ZMedicare PIN