Provider Demographics
NPI:1710298211
Name:JOSE L. ESTRELLA
Entity Type:Organization
Organization Name:JOSE L. ESTRELLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ESTRELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-858-8966
Mailing Address - Street 1:16840 CLAY RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-4228
Mailing Address - Country:US
Mailing Address - Phone:281-858-8966
Mailing Address - Fax:281-858-8506
Practice Address - Street 1:13225 FM 529 RD STE 109
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-2661
Practice Address - Country:US
Practice Address - Phone:281-858-8966
Practice Address - Fax:281-858-8506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2817967-01Medicaid
TX6489070001Medicare NSC