Healthcare Provider Details

I. General information

NPI: 1801370127
Provider Name (Legal Business Name): CALIFORNIA ESTRADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 08/14/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18888 HIGHWAY 18 SUITE 106
APPLE VALLEY CA
92307
US

IV. Provider business mailing address

12708 5TH AVE
VICTORVILLE CA
92395-9424
US

V. Phone/Fax

Practice location:
  • Phone: 760-961-5370
  • Fax:
Mailing address:
  • Phone: 760-243-3820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: