Healthcare Provider Details

I. General information

NPI: 1053037754
Provider Name (Legal Business Name): NEIRA MARIANA ESTERWOLD MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 BEHAVIORAL HEALTH 16380 ROSCOE BLVD. STE 100
VAN NUYS CA
91406
US

IV. Provider business mailing address

278 HYDRANGEA ST
FILLMORE CA
93015-1897
US

V. Phone/Fax

Practice location:
  • Phone: 747-221-4197
  • Fax:
Mailing address:
  • Phone: 805-317-9556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: