Healthcare Provider Details

I. General information

NPI: 1114589819
Provider Name (Legal Business Name): ANAI ESTEBAN BA, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 KELLOGG AVE
CORONA CA
92879-3111
US

IV. Provider business mailing address

2055 KELLOGG AVE
CORONA CA
92879-3111
US

V. Phone/Fax

Practice location:
  • Phone: 951-898-7910
  • Fax:
Mailing address:
  • Phone: 951-898-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number125758
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number125758
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number91237
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: