Provider Demographics
NPI:1043388507
Name:ESTRADA, JOSE M
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:M
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S 4TH ST
Mailing Address - Street 2:#503
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-3600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:160 E VIRGINIA ST
Practice Address - Street 2:#280
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5857
Practice Address - Country:US
Practice Address - Phone:408-287-6200
Practice Address - Fax:408-998-1535
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor