Healthcare Provider Details

I. General information

NPI: 1073447132
Provider Name (Legal Business Name): DANA KATHLEEN ELLAZAR ESTIPONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 UNION AVE
SAN JOSE CA
95124-5156
US

IV. Provider business mailing address

750 ALMA LANE STE 100, #4012
FOSTER CITY CA
94404
US

V. Phone/Fax

Practice location:
  • Phone: 800-913-2615
  • Fax:
Mailing address:
  • Phone: 341-204-0539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number148925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: