Provider Demographics
NPI:1851825707
Name:ESTALA, LUIS
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:ESTALA
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 1:1324 WEATHERVANE LN APT 2B
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-5128
Mailing Address - Country:US
Mailing Address - Phone:330-972-2010
Mailing Address - Fax:
Practice Address - Street 1:1324 WEATHERVANE LN APT 2B
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-5128
Practice Address - Country:US
Practice Address - Phone:330-972-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer