Healthcare Provider Details

I. General information

NPI: 1164387858
Provider Name (Legal Business Name): CARLA ESTRADA-HIDALGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 TEAGARDEN ST
SAN LEANDRO CA
94577-4340
US

IV. Provider business mailing address

2600 TEAGARDEN ST
SAN LEANDRO CA
94577-4340
US

V. Phone/Fax

Practice location:
  • Phone: 510-667-3552
  • Fax:
Mailing address:
  • Phone: 510-667-3500
  • Fax: 510-667-6234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberF4780B702B
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: