Provider Demographics
NPI:1235369521
Name:ESTRADA, ELSA A (PHN, RN, BSN)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:A
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:PHN, RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14215 ROAD 28
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-5729
Mailing Address - Country:US
Mailing Address - Phone:559-675-7893
Mailing Address - Fax:559-674-7262
Practice Address - Street 1:14215 ROAD 28
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-5729
Practice Address - Country:US
Practice Address - Phone:559-675-7893
Practice Address - Fax:559-674-7262
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA769628 RN 77546 PHN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health