Healthcare Provider Details

I. General information

NPI: 1770831521
Provider Name (Legal Business Name): AILEEN SABIO ESTRADA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E VALENCIA MESA DR SUITE 310
FULLERTON CA
92835-3813
US

IV. Provider business mailing address

100 E VALENCIA MESA DR STE 310
FULLERTON CA
92835-3800
US

V. Phone/Fax

Practice location:
  • Phone: 714-446-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number22453
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: