Healthcare Provider Details

I. General information

NPI: 1740948520
Provider Name (Legal Business Name): LUIS FERNANDO ESTRADA RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 11/29/2021
Certification Date: 11/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 PUTNAM WAY
ARBUCKLE CA
95912-9814
US

IV. Provider business mailing address

1868 OAK RIM WAY
SACRAMENTO CA
95833-1506
US

V. Phone/Fax

Practice location:
  • Phone: 530-476-2200
  • Fax:
Mailing address:
  • Phone: 408-712-9135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number31205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: