MEDICARE: MRS. GINA MARIA ESTRADA LVN

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	101YM0800X	Mental Health Counselor	173785	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	173785	OTHER	CA	LVN

General Provider Information

NPI Number	:	1528205457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GINA MARIA ESTRADA LVN

Provider Business Mailing Address
First Line	:	4342 HEDDA ST
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-1135
Country	:	US
Telephone Number	:	562-920-6647
Fax Number	:

Provider Business Practice Location Address
First Line	:	4342 HEDDA ST
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-1135
Country	:	US
Telephone Number	:	562-920-6647
Fax Number	:

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

Provider Enumeration Date	:	01/14/2009
Last Update Date	:	01/14/2009

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