Provider Demographics
NPI:1083246623
Name:ESTRADA, MILINDA CHIDERA (PA-C)
Entity Type:Individual
Prefix:
First Name:MILINDA
Middle Name:CHIDERA
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MILINDA
Other - Middle Name:CHIDERA
Other - Last Name:AJAWARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3151 AIRWAY AVE # R
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4607
Mailing Address - Country:US
Mailing Address - Phone:949-288-5377
Mailing Address - Fax:
Practice Address - Street 1:3151 AIRWAY AVE # R
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4607
Practice Address - Country:US
Practice Address - Phone:949-288-5377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57745363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty