Provider Demographics
NPI:1407678063
Name:ESTELLE, MIA
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:ESTELLE
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 1:24100 CHAGRIN BLVD
Mailing Address - Street 2:STE. #250
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44112-5363
Mailing Address - Country:US
Mailing Address - Phone:216-600-2889
Mailing Address - Fax:
Practice Address - Street 1:24100 CHAGRIN BLVD
Practice Address - Street 2:STE. #250
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44112-5363
Practice Address - Country:US
Practice Address - Phone:216-600-2889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty