Healthcare Provider Details

I. General information

NPI: 1013402437
Provider Name (Legal Business Name): JENNA ESTRADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HOSPITAL CIR
WESTMINSTER CA
92683-3910
US

IV. Provider business mailing address

3032 N GAYLE ST
ORANGE CA
92865-1607
US

V. Phone/Fax

Practice location:
  • Phone: 714-893-4541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number288589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: