Provider Demographics
NPI:1538239876
Name:ESTRELLA SPECIALTY MEDICAL CARE P C
Entity type:Organization
Organization Name:ESTRELLA SPECIALTY MEDICAL CARE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERMINIA
Authorized Official - Middle Name:GUMABAY
Authorized Official - Last Name:HERRERA-TAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-246-2376
Mailing Address - Street 1:9515 W CAMELBACK RD STE 136
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-1364
Mailing Address - Country:US
Mailing Address - Phone:623-322-8906
Mailing Address - Fax:623-322-8430
Practice Address - Street 1:9515 W CAMELBACK RD STE 136
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-1364
Practice Address - Country:US
Practice Address - Phone:623-322-8906
Practice Address - Fax:623-322-8430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29828261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care