MEDICARE: HARRIET TUBMAN VILLAGE CHARTER SCHOOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1588597488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRIET TUBMAN VILLAGE CHARTER SCHOOL

Provider Business Mailing Address
First Line	:	6880 MOHAWK ST # 18
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-1728
Country	:	US
Telephone Number	:	858-213-5403
Fax Number	:

Provider Business Practice Location Address
First Line	:	6880 MOHAWK ST # 18
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-1728
Country	:	US
Telephone Number	:	858-213-5403
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	DR. ISAAC ESTRADA
Credential	:	ED.D.
Telephone Number	:	858-213-5403

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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Directions to “HARRIET TUBMAN VILLAGE CHARTER SCHOOL ” Practice Location

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