Healthcare Provider Details

I. General information

NPI: 1083420095
Provider Name (Legal Business Name): SANDRA ESTRADA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 CASA VERDE WAY
MONTEREY CA
93940-3753
US

IV. Provider business mailing address

1238 BUNDAGE CT
MARINA CA
93933-5006
US

V. Phone/Fax

Practice location:
  • Phone: 831-717-4630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: