Provider Demographics
NPI:1184398372
Name:ESTELL, CORNELIA SHARON (NP)
Entity type:Individual
Prefix:
First Name:CORNELIA
Middle Name:SHARON
Last Name:ESTELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CORNELIA
Other - Middle Name:SHARON
Other - Last Name:ESTELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:2100 REDONDO BEACH BLVD # C122
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-1683
Mailing Address - Country:US
Mailing Address - Phone:310-722-3497
Mailing Address - Fax:
Practice Address - Street 1:3451 W CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-1227
Practice Address - Country:US
Practice Address - Phone:310-677-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily