MEDICARE: JAN ESTRELLADO PHD

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	103T00000X	Psychologist	PSY28881	CA

General Provider Information

NPI Number	:	1073809257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN ESTRELLADO PHD

Provider Business Mailing Address
First Line	:	2729 4TH AVE STE 3
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-6223
Country	:	US
Telephone Number	:	619-363-1618
Fax Number	:

Provider Business Practice Location Address
First Line	:	2729 4TH AVE STE 3
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-6223
Country	:	US
Telephone Number	:	619-363-1618
Fax Number	:

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

Provider Enumeration Date	:	06/25/2011
Last Update Date	:	05/27/2026

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