Provider Demographics
NPI:1033104161
Name:ESTRADA, YOLY MALANYAON (DDS)
Entity Type:Individual
Prefix:DR
First Name:YOLY
Middle Name:MALANYAON
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:YOLY
Other - Middle Name:ARINDAENG
Other - Last Name:MALANYAON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:451 S BRAND BLVD
Mailing Address - Street 2:206
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-3640
Mailing Address - Country:US
Mailing Address - Phone:818-838-7030
Mailing Address - Fax:818-838-7003
Practice Address - Street 1:451 S BRAND BLVD
Practice Address - Street 2:206
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3640
Practice Address - Country:US
Practice Address - Phone:818-838-7030
Practice Address - Fax:818-838-7003
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice