Provider Demographics
NPI:1174492896
Name:ESTRADA, MARCELLO VINCENT
Entity type:Individual
Prefix:MR
First Name:MARCELLO
Middle Name:VINCENT
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23835 SECRETARIAT LN
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6529
Mailing Address - Country:US
Mailing Address - Phone:831-601-6603
Mailing Address - Fax:
Practice Address - Street 1:157 SARGENT CT
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3115
Practice Address - Country:US
Practice Address - Phone:831-601-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-31
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health