Provider Demographics
NPI:1902105851
Name:ESTRELLA, MARIA D
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:ESTRELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6323 MEMORIAL HWY
Mailing Address - Street 2:BUILDING A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4509
Mailing Address - Country:US
Mailing Address - Phone:813-891-9474
Mailing Address - Fax:813-891-9058
Practice Address - Street 1:6323 MEMORIAL HWY
Practice Address - Street 2:BUILDING A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4509
Practice Address - Country:US
Practice Address - Phone:813-891-9474
Practice Address - Fax:813-891-9058
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11998101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health