Provider Demographics
NPI:1104388214
Name:ESTRADA, LINDSAY (PHD, RDN)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:PHD, RDN
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:WINSOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9740 SHADOW MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-3528
Mailing Address - Country:US
Mailing Address - Phone:951-312-3813
Mailing Address - Fax:
Practice Address - Street 1:9740 SHADOW MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-3528
Practice Address - Country:US
Practice Address - Phone:951-312-3813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty