MEDICARE: CECILIA ESTRADA 776006066

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	126800000X	Dental Assistant	776006066	CA

General Provider Information

NPI Number	:	1689811762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECILIA ESTRADA 776006066

Provider Business Mailing Address
First Line	:	10131 MCNERNEY AVE
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-6205
Country	:	US
Telephone Number	:	213-977-4901
Fax Number	:

Provider Business Practice Location Address
First Line	:	10131 MCNERNEY AVE
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-6205
Country	:	US
Telephone Number	:	213-977-4901
Fax Number	:

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

Provider Enumeration Date	:	01/12/2009
Last Update Date	:	01/12/2009

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