Healthcare Provider Details

I. General information

NPI: 1295658177
Provider Name (Legal Business Name): ABBEY L ESTRADA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9211 3RD PL SE
EVERETT WA
98208-2744
US

IV. Provider business mailing address

9211 3RD PL SE
EVERETT WA
98208-2744
US

V. Phone/Fax

Practice location:
  • Phone: 505-377-3292
  • Fax: 505-377-3292
Mailing address:
  • Phone: 505-377-3292
  • Fax: 505-377-3292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI61498961
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: