MEDICARE: CRYSTAL ESTRADA

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	A207252	CA

General Provider Information

NPI Number	:	1952003899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL ESTRADA

Provider Business Mailing Address
First Line	:	1770 N ORANGE GROVE AVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-3027
Country	:	US
Telephone Number	:	909-469-9494
Fax Number	:

Provider Business Practice Location Address
First Line	:	1770 N ORANGE GROVE AVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-3027
Country	:	US
Telephone Number	:	909-469-9494
Fax Number	:

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

Provider Enumeration Date	:	03/21/2023
Last Update Date	:	06/03/2026

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1316947351 — LYNNE MARIE DIAMOND MD
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Directions to “ CRYSTAL ESTRADA ” Practice Location

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