MEDICARE: DR. GLORIA ESTRADA O.D

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	152WC0802X	Corneal and Contact Management Optometrist	13843	CA
2	152W00000X	Optometrist	13843	CA

General Provider Information

NPI Number	:	1992937197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLORIA ESTRADA O.D

Provider Business Mailing Address
First Line	:	393 E WALNUT ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91188-0001
Country	:	US
Telephone Number	:	626-664-7315
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 HEDGEPATH AVE
Second Line	:
City	:	HACIENDA HTS
State	:	CA
Zip	:	91745-3233
Country	:	US
Telephone Number	:	626-664-7315
Fax Number	:

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

Provider Enumeration Date	:	08/20/2009
Last Update Date	:	12/08/2021

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