Provider Demographics
NPI:1821664053
Name:VINCENT, ESTELLE CHARLOTTE (MD)
Entity type:Individual
Prefix:
First Name:ESTELLE
Middle Name:CHARLOTTE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 W CENTRAL AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3066
Mailing Address - Country:US
Mailing Address - Phone:949-378-4063
Mailing Address - Fax:
Practice Address - Street 1:380 W CENTRAL AVE STE 230
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3066
Practice Address - Country:US
Practice Address - Phone:714-482-2775
Practice Address - Fax:714-482-2779
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT223239207Q00000X
CAA198772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine