Healthcare Provider Details

I. General information

NPI: 1497863252
Provider Name (Legal Business Name): STELLA M ESTRUCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 05/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7481 W OAKLAND PARK BOULEVARD SUITE 100
LAUDERHILL FL
33319-4985
US

IV. Provider business mailing address

1065 NE 125TH STREET SUITE 409
NORTH MIAMI FL
33161-5834
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-7743
  • Fax: 954-771-7748
Mailing address:
  • Phone: 888-852-6672
  • Fax: 877-720-0502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME 94602
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME94602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: