Provider Demographics
NPI:1245553163
Name:RODRIGUEZ-CABRERA, ESTELA M
Entity type:Individual
Prefix:
First Name:ESTELA
Middle Name:M
Last Name:RODRIGUEZ-CABRERA
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 1:11902 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2422
Mailing Address - Country:US
Mailing Address - Phone:718-529-9503
Mailing Address - Fax:
Practice Address - Street 1:11902 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2422
Practice Address - Country:US
Practice Address - Phone:718-529-9503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH59194183500000X
NJ28RI03335300183500000X
NY1041931-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist