Healthcare Provider Details

I. General information

NPI: 1750146205
Provider Name (Legal Business Name): YAEKO DAWE ESTRADA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 GATEWAY DR STE 210
LINCOLN CA
95648-3306
US

IV. Provider business mailing address

110 GATEWAY DR STE 210
LINCOLN CA
95648-3306
US

V. Phone/Fax

Practice location:
  • Phone: 650-763-6674
  • Fax:
Mailing address:
  • Phone: 650-763-6674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: