Provider Demographics
NPI:1952744773
Name:EVERETT, ESTELLE MARLA (MD)
Entity Type:Individual
Prefix:
First Name:ESTELLE
Middle Name:MARLA
Last Name:EVERETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ESTELLE
Other - Middle Name:MARLA
Other - Last Name:EUGENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-301-5138
Mailing Address - Fax:
Practice Address - Street 1:27235 TOURNEY RD STE 2500
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5908
Practice Address - Country:US
Practice Address - Phone:661-253-5851
Practice Address - Fax:661-253-5852
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0000000207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism