Provider Demographics
NPI:1144796939
Name:ESTRADA, CACILDA (LVN)
Entity Type:Individual
Prefix:
First Name:CACILDA
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 411
Mailing Address - Street 2:
Mailing Address - City:MUNDAY
Mailing Address - State:TX
Mailing Address - Zip Code:76371-0411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 NTH MUNDAY AVE.
Practice Address - Street 2:
Practice Address - City:MUNDAY
Practice Address - State:TX
Practice Address - Zip Code:76371
Practice Address - Country:US
Practice Address - Phone:940-203-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341135164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse