Provider Demographics
NPI:1922632041
Name:TETITLA, ESTELA MICHELLE
Entity Type:Individual
Prefix:
First Name:ESTELA
Middle Name:MICHELLE
Last Name:TETITLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15063 DANBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-1422
Mailing Address - Country:US
Mailing Address - Phone:562-567-1586
Mailing Address - Fax:
Practice Address - Street 1:15063 DANBROOK DR
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604-1422
Practice Address - Country:US
Practice Address - Phone:562-567-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer