Provider Demographics
NPI:1538208236
Name:ESTRELLA, GUSTAVO E (MD)
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:E
Last Name:ESTRELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 SOUTH ATLANTIC AVENUE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201
Mailing Address - Country:US
Mailing Address - Phone:323-326-1618
Mailing Address - Fax:323-562-9208
Practice Address - Street 1:6901 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201
Practice Address - Country:US
Practice Address - Phone:323-326-1618
Practice Address - Fax:323-562-9208
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA62006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A620060Medicaid
CA00A620060Medicaid