Provider Demographics
NPI:1699704437
Name:ESTASSI-MARTIN, SANDRELLA (DC)
Entity type:Individual
Prefix:DR
First Name:SANDRELLA
Middle Name:
Last Name:ESTASSI-MARTIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 CRUMLEY WAY
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-6242
Mailing Address - Country:US
Mailing Address - Phone:559-801-5161
Mailing Address - Fax:
Practice Address - Street 1:1960 DEL PASO RD STE 145
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-7709
Practice Address - Country:US
Practice Address - Phone:916-285-9387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27426111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0274260Medicare ID - Type Unspecified