Provider Demographics
NPI:1063066496
Name:SANDOVAL-BECKER, ESTRELLA MARINA (NMD)
Entity type:Individual
Prefix:DR
First Name:ESTRELLA
Middle Name:MARINA
Last Name:SANDOVAL-BECKER
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 E GUADALUPE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3935
Mailing Address - Country:US
Mailing Address - Phone:480-330-4818
Mailing Address - Fax:833-301-0796
Practice Address - Street 1:1631 E GUADALUPE RD STE 104
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3935
Practice Address - Country:US
Practice Address - Phone:480-330-4818
Practice Address - Fax:833-301-0796
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19-1808208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ19-1808OtherGENERAL MED