Provider Demographics
NPI:1659621027
Name:ESTRELLA, LORILITA
Entity Type:Individual
Prefix:
First Name:LORILITA
Middle Name:
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 1:3272 STEINWAY ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4182
Mailing Address - Country:US
Mailing Address - Phone:917-388-0234
Mailing Address - Fax:
Practice Address - Street 1:3272 STEINWAY ST
Practice Address - Street 2:SUITE 301
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4182
Practice Address - Country:US
Practice Address - Phone:917-388-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist