Provider Demographics
NPI:1285947572
Name:ESTRERA, LUIS GALLO JR (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:GALLO
Last Name:ESTRERA
Suffix:JR
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 1:2328 BLUE RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-4158
Mailing Address - Country:US
Mailing Address - Phone:925-240-6641
Mailing Address - Fax:
Practice Address - Street 1:2328 BLUE RIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4158
Practice Address - Country:US
Practice Address - Phone:925-240-6641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE29592207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A295920Medicare PIN
CAA25821Medicare UPIN