Healthcare Provider Details

I. General information

NPI: 1922687706
Provider Name (Legal Business Name): VALERIE ROXANE ESTRADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18302 IRVINE BLVD STE 375
TUSTIN CA
92780-3435
US

IV. Provider business mailing address

18302 IRVINE BLVD STE 375
TUSTIN CA
92780-3435
US

V. Phone/Fax

Practice location:
  • Phone: 714-661-5402
  • Fax:
Mailing address:
  • Phone: 714-661-5402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: