Provider Demographics
NPI:1982352803
Name:ESTAVILLA, JEE
Entity Type:Individual
Prefix:
First Name:JEE
Middle Name:
Last Name:ESTAVILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 DOUGLAS DR APT 127
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7843
Mailing Address - Country:US
Mailing Address - Phone:406-381-0849
Mailing Address - Fax:
Practice Address - Street 1:275 DOUGLAS DR APT 127
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7843
Practice Address - Country:US
Practice Address - Phone:406-381-0849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN-127444163W00000X
CA95273779163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse