Healthcare Provider Details

I. General information

NPI: 1124205976
Provider Name (Legal Business Name): MR. DONALD ESTRADA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALLERTON ST SUITE 200
REDWOOD CITY CA
94063-1519
US

IV. Provider business mailing address

500 ALLERTON ST SUITE 200
REDWOOD CITY CA
94063-1519
US

V. Phone/Fax

Practice location:
  • Phone: 650-599-9955
  • Fax: 650-599-9955
Mailing address:
  • Phone: 650-599-9955
  • Fax: 650-599-9955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: