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General NPI Number Information
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NPI Number | 1851241467
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Entity Type | Organization
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Legal Business Name | WELL CARE OF ESTRELL, LLC
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 1350 TRAVIS BLVD UNIT 1385A
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City | FAIRFIELD
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State | CA
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Zip | 94533-3433
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Country | US
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Telephone | 707-631-6416
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 TRAVIS BLVD UNIT 1385A
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City | FAIRFIELD
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State | CA
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Zip | 94533-3433
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Country | US
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Telephone | 707-631-6416
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Fax |
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | AMANDA LISTON
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Credential |
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Telephone | 805-616-1765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State |
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