Provider Demographics
NPI:1316423791
Name:WAHNICH, ESTRELLA N/A
Entity type:Individual
Prefix:MRS
First Name:ESTRELLA
Middle Name:N/A
Last Name:WAHNICH
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 1:1900 N 29TH AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-1746
Mailing Address - Country:US
Mailing Address - Phone:954-465-9469
Mailing Address - Fax:
Practice Address - Street 1:1900 N 29TH AVE APT 301
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-1746
Practice Address - Country:US
Practice Address - Phone:954-465-9469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician