Provider Demographics
NPI:1568138154
Name:ESTRELLA, IVONNE MARIE
Entity Type:Individual
Prefix:MS
First Name:IVONNE
Middle Name:MARIE
Last Name:ESTRELLA
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 1:124 CAPULET DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-4538
Mailing Address - Country:US
Mailing Address - Phone:904-492-3859
Mailing Address - Fax:
Practice Address - Street 1:124 CAPULET DR UNIT 102124
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-4537
Practice Address - Country:US
Practice Address - Phone:904-429-3859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician