Provider Demographics
NPI:1336853688
Name:ESTUDILLO, PATRICK (FNP-BC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:ESTUDILLO
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14665 PRAIRIE SMOKE RD
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9146
Mailing Address - Country:US
Mailing Address - Phone:626-251-0418
Mailing Address - Fax:
Practice Address - Street 1:5050 PALO VERDE ST STE 101
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2333
Practice Address - Country:US
Practice Address - Phone:909-625-5518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023825363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner