Provider Demographics
NPI:1083497150
Name:ESTRADA, ISABELLA MALIEGH
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:MALIEGH
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 GARGONZA CT
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-2588
Mailing Address - Country:US
Mailing Address - Phone:941-705-1657
Mailing Address - Fax:
Practice Address - Street 1:6845 CAMPUS DR STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3107
Practice Address - Country:US
Practice Address - Phone:718-822-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician