Provider Demographics
NPI:1689292765
Name:ESTRELLA, MARVIN VENTURA
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:VENTURA
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 1:19308 FAGAN CT
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6932
Mailing Address - Country:US
Mailing Address - Phone:310-986-4490
Mailing Address - Fax:562-991-5264
Practice Address - Street 1:19308 FAGAN CT
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6932
Practice Address - Country:US
Practice Address - Phone:310-986-4490
Practice Address - Fax:562-991-5264
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No253Z00000XAgenciesIn Home Supportive Care