MEDICARE: NATALY ESTRADA BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-23-64681

General Provider Information

NPI Number	:	1063287209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALY ESTRADA BCBA

Provider Business Mailing Address
First Line	:	11173 PIGGOTT DR
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-3909
Country	:	US
Telephone Number	:	310-486-2943
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 HANNUM AVE STE B
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6525
Country	:	US
Telephone Number	:	424-362-8405
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2023
Last Update Date	:	11/17/2023

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