MEDICARE: ELVIRA ESTRELLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	275101	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417518705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELVIRA ESTRELLA

Provider Business Mailing Address
First Line	:	11033 72ND AVE
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4947
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11033 72ND AVE
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4947
Country	:	US
Telephone Number	:	347-639-2265
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	06/26/2019

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Directions to “ ELVIRA ESTRELLA ” Practice Location

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