Provider Demographics
NPI:1770766016
Name:ESTRELLA SURGICAL GROUP
Entity type:Organization
Organization Name:ESTRELLA SURGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GLADDING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-936-5406
Mailing Address - Street 1:9305 W THOMAS RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3328
Mailing Address - Country:US
Mailing Address - Phone:623-936-5406
Mailing Address - Fax:623-936-5479
Practice Address - Street 1:9305 W THOMAS RD
Practice Address - Street 2:SUITE 250
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3328
Practice Address - Country:US
Practice Address - Phone:623-936-5406
Practice Address - Fax:623-936-5479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ119755Medicare PIN