Provider Demographics
NPI:1780860379
Name:ESTRELLA, PAUL (MT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:ESTRELLA
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-2003
Mailing Address - Country:US
Mailing Address - Phone:971-246-3416
Mailing Address - Fax:503-397-7729
Practice Address - Street 1:203 S 1ST ST
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-2003
Practice Address - Country:US
Practice Address - Phone:971-246-3416
Practice Address - Fax:503-397-7729
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13463174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist