Provider Demographics
NPI:1982352803
Name:ESTAVILLA, JEE IRENE (RN BSN PMHNP-BC)
Entity type:Individual
Prefix:MISS
First Name:JEE
Middle Name:IRENE
Last Name:ESTAVILLA
Suffix:
Gender:F
Credentials:RN BSN PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 PIPPIN DR
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3485
Mailing Address - Country:US
Mailing Address - Phone:406-381-0849
Mailing Address - Fax:
Practice Address - Street 1:362 PIPPIN DR
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3485
Practice Address - Country:US
Practice Address - Phone:406-381-0849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95273779163WP0808X
CA95033024363LP0808X
MTRN-127444163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse