Healthcare Provider Details

I. General information

NPI: 1215698675
Provider Name (Legal Business Name): ESTRA HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 KAREN AVE
LAS VEGAS NV
89169-1260
US

IV. Provider business mailing address

8612 COPPER KNOLL AVE
LAS VEGAS NV
89129-7649
US

V. Phone/Fax

Practice location:
  • Phone: 725-502-7699
  • Fax:
Mailing address:
  • Phone: 323-338-6101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MA VICTORIA ESCARDA
Title or Position: OWNER/CLINICIAN
Credential: APRN
Phone: 323-338-6101