Healthcare Provider Details

I. General information

NPI: 1285543223
Provider Name (Legal Business Name): DIANA ROSE ESTRADA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 MISSION GORGE RD STE 200
SAN DIEGO CA
92120-3411
US

IV. Provider business mailing address

6160 MISSION GORGE RD STE 200
SAN DIEGO CA
92120-3411
US

V. Phone/Fax

Practice location:
  • Phone: 858-239-8318
  • Fax:
Mailing address:
  • Phone: 858-239-8318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number140355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: