Healthcare Provider Details

I. General information

NPI: 1073809257
Provider Name (Legal Business Name): JAN ESTRELLADO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2011
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2729 4TH AVE STE 3
SAN DIEGO CA
92103-6223
US

IV. Provider business mailing address

2729 4TH AVE STE 3
SAN DIEGO CA
92103-6223
US

V. Phone/Fax

Practice location:
  • Phone: 619-363-1618
  • Fax:
Mailing address:
  • Phone: 619-363-1618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY28881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: