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General NPI Number Information
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NPI Number | 1811274152
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Entity Type | Individual
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Provider Name | JUAN FERNANDO ESTRADA
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Gender | Male
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 5275 MARKET ST SUITE # E
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City | SAN DIEGO
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State | CA
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Zip | 92114-2212
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Country | US
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Telephone | 619-857-4775
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Fax |
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Provider Business Mailing Address
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Address Line | 5275 MARKET ST SUITE # E
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City | SAN DIEGO
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State | CA
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Zip | 92114-2212
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Country | US
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Telephone | 619-857-4775
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | MPSS-LQGYTK
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License Number State | CA
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