MEDICARE: ROMELDA CAPITLY ESTRADA NP

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	363LF0000X	Family Nurse Practitioner	NP95027012	CA

General Provider Information

NPI Number	:	1841061470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMELDA CAPITLY ESTRADA NP

Provider Business Mailing Address
First Line	:	118 W FOOTHILL BLVD
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-3364
Country	:	US
Telephone Number	:	626-914-3871
Fax Number	:	626-914-3871

Provider Business Practice Location Address
First Line	:	118 W FOOTHILL BLVD
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-3364
Country	:	US
Telephone Number	:	626-914-3871
Fax Number	:	626-914-3871

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

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	07/23/2024

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