Healthcare Provider Details

I. General information

NPI: 1982352803
Provider Name (Legal Business Name): JEE IRENE ESTAVILLA RN BSN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 PLAZA DR STE 170
FOLSOM CA
95630-4790
US

IV. Provider business mailing address

362 PIPPIN DR
FALLBROOK CA
92028-3485
US

V. Phone/Fax

Practice location:
  • Phone: 916-351-9400
  • Fax:
Mailing address:
  • Phone: 442-637-2634
  • Fax: 760-557-7428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95033024
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-127444
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95273779
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberNUR-APRN-LIC-269167
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: