Healthcare Provider Details

I. General information

NPI: 1831617992
Provider Name (Legal Business Name): ANDREW CARLOS ESTRELLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

572 N ARROWHEAD AVE #200
SAN BERNARDINO CA
92401
US

IV. Provider business mailing address

572 N ARROWHEAD AVE STE 200
SAN BERNARDINO CA
92401-1212
US

V. Phone/Fax

Practice location:
  • Phone: 909-659-5921
  • Fax:
Mailing address:
  • Phone: 909-659-5921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW102191
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: