Provider Demographics
NPI:1801269576
Name:ESTRELLA, OMAYRA
Entity type:Individual
Prefix:
First Name:OMAYRA
Middle Name:
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 1:8838 53RD AVE
Mailing Address - Street 2:APT. 3F
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4531
Mailing Address - Country:US
Mailing Address - Phone:917-279-1925
Mailing Address - Fax:
Practice Address - Street 1:8838 53RD AVE
Practice Address - Street 2:APT 3F
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4531
Practice Address - Country:US
Practice Address - Phone:917-279-1925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY644879174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist