Provider Demographics
NPI:1235700451
Name:ESTRADA, ANGEL JOY MALANYAON (RDHAP)
Entity Type:Individual
Prefix:MS
First Name:ANGEL JOY
Middle Name:MALANYAON
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17414 WINTER PINE WAY
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-6877
Mailing Address - Country:US
Mailing Address - Phone:818-205-5307
Mailing Address - Fax:
Practice Address - Street 1:17414 WINTER PINE WAY
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-6877
Practice Address - Country:US
Practice Address - Phone:818-205-5307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30613124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist