Provider Demographics
NPI:1821048083
Name:ESTRELLA, JENNIFER L (NP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:ESTRELLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11480 BROOKSHIRE AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5010
Mailing Address - Country:US
Mailing Address - Phone:562-904-1651
Mailing Address - Fax:562-904-1656
Practice Address - Street 1:11480 BROOKSHIRE AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5010
Practice Address - Country:US
Practice Address - Phone:562-904-1651
Practice Address - Fax:562-904-1656
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN305947363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0080690OtherMEDI-CAL
CAZZZ54573ZOtherBLUE SHIELD
CA0007364697OtherAETNA
CAGR0080690Medicaid
CAGR0080690Medicaid