Healthcare Provider Details

I. General information

NPI: 1275476798
Provider Name (Legal Business Name): IVETTE BERENICE ESTRADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E AVENUE R4
PALMDALE CA
93550-6185
US

IV. Provider business mailing address

39139 10TH ST E
PALMDALE CA
93550-3419
US

V. Phone/Fax

Practice location:
  • Phone: 661-273-4166
  • Fax:
Mailing address:
  • Phone: 661-947-7191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number230132800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: