Provider Demographics
NPI:1649794504
Name:ESTRELLA, SEAN PHILLIP (LPT)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:PHILLIP
Last Name:ESTRELLA
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 E E ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-3712
Mailing Address - Country:US
Mailing Address - Phone:909-983-4466
Mailing Address - Fax:
Practice Address - Street 1:316 E E ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-3712
Practice Address - Country:US
Practice Address - Phone:909-983-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35131167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician