Provider Demographics
NPI:1801007588
Name:ASEJO, ESTRELLA PINEDA (MD)
Entity Type:Individual
Prefix:
First Name:ESTRELLA
Middle Name:PINEDA
Last Name:ASEJO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-1726
Mailing Address - Country:US
Mailing Address - Phone:661-725-7299
Mailing Address - Fax:661-725-2196
Practice Address - Street 1:1419 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-1726
Practice Address - Country:US
Practice Address - Phone:661-725-7299
Practice Address - Fax:661-725-2196
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208D00000X208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A377180Medicaid