MEDICARE: JOSE L. 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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies

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	:	1710298211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE L. ESTRELLA

Provider Business Mailing Address
First Line	:	16840 CLAY RD
Second Line	:	SUITE 117
City	:	HOUSTON
State	:	TX
Zip	:	77084-4228
Country	:	US
Telephone Number	:	281-858-8966
Fax Number	:	281-858-8506

Provider Business Practice Location Address
First Line	:	13225 FM 529 RD STE 109
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77041-2661
Country	:	US
Telephone Number	:	281-858-8966
Fax Number	:	281-858-8506

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOSE L ESTRELLA
Credential	:
Telephone Number	:	281-858-8966

Provider Enumeration Date	:	06/30/2010
Last Update Date	:	01/23/2018

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Directions to “JOSE L. ESTRELLA ” Practice Location

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