Healthcare Provider Details

I. General information

NPI: 1780511345
Provider Name (Legal Business Name): ALESSANDRA GIANNA ESTRADA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COSMO ESTRADA

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20700 CIVIC CENTER DR
SOUTHFIELD MI
48076-4140
US

IV. Provider business mailing address

24519 CORNELL AVE
BROWNSTOWN TWP MI
48183-3086
US

V. Phone/Fax

Practice location:
  • Phone: 800-385-1035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: