Healthcare Provider Details

I. General information

NPI: 1407687304
Provider Name (Legal Business Name): CLARISSA ESTRELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 360
LA JOLLA CA
92037-1212
US

IV. Provider business mailing address

10937 BELGIAN ST
SAN DIEGO CA
92126-2408
US

V. Phone/Fax

Practice location:
  • Phone: 858-626-5925
  • Fax: 858-404-1277
Mailing address:
  • Phone: 858-265-9760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number744478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: