Provider Demographics
NPI:1073041182
Name:ESTRADA, CECILIA VERONICA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:VERONICA
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 N AVON ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-1817
Mailing Address - Country:US
Mailing Address - Phone:323-627-5403
Mailing Address - Fax:
Practice Address - Street 1:1438 N AVON ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1817
Practice Address - Country:US
Practice Address - Phone:323-627-5403
Practice Address - Fax:323-627-5403
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA664472363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily