Provider Demographics
NPI:1811152481
Name:DR. EDUARDO F. ESTELLA, PSC
Entity type:Organization
Organization Name:DR. EDUARDO F. ESTELLA, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-707-0059
Mailing Address - Street 1:AVE ORTEGON # 107
Mailing Address - Street 2:CAPARRA GALLERY SUITE 212
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2508
Mailing Address - Country:US
Mailing Address - Phone:787-707-0059
Mailing Address - Fax:
Practice Address - Street 1:PMB 254 1353
Practice Address - Street 2:RD 19
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-707-0059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14164207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14164OtherPUERTO RICO MEDICAL BOARD
PRH65277Medicare UPIN