Healthcare Provider Details

I. General information

NPI: 1609704261
Provider Name (Legal Business Name): MRS. JOHANA FARIAS-ESTRADA I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 S GLENDORA AVE
WEST COVINA CA
91790-4924
US

IV. Provider business mailing address

664 CLARK AVE
POMONA CA
91767-5010
US

V. Phone/Fax

Practice location:
  • Phone: 626-739-3686
  • Fax:
Mailing address:
  • Phone: 626-739-3686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number10287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: