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General NPI Number Information
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NPI Number | 1336853688
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Entity Type | Individual
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Provider Name | PATRICK ESTUDILLO FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 01/11/2023
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 5050 PALO VERDE ST STE 101
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City | MONTCLAIR
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State | CA
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Zip | 91763-2333
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Country | US
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Telephone | 909-625-5518
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Fax |
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Provider Business Mailing Address
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Address Line | 14665 PRAIRIE SMOKE RD
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City | EASTVALE
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State | CA
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Zip | 92880-9146
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Country | US
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Telephone | 626-251-0418
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95023825
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License Number State | CA
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