Healthcare Provider Details

I. General information

NPI: 1073175873
Provider Name (Legal Business Name): LORRAINE MARGARET ESTRONICK AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORRAINE MARGARET VASHAW

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15031 RINALDI ST
MISSION HILLS CA
91345-1207
US

IV. Provider business mailing address

1138 9TH ST APT D
SANTA MONICA CA
90403-5209
US

V. Phone/Fax

Practice location:
  • Phone: 818-365-8051
  • Fax:
Mailing address:
  • Phone: 805-428-0971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95012061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: