Provider Demographics
NPI:1245406503
Name:ESTRADA, RAUL (DC, PA-C)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:DC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 PICADOR BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-3565
Mailing Address - Country:US
Mailing Address - Phone:619-428-2390
Mailing Address - Fax:
Practice Address - Street 1:1270 PICADOR BLVD STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-3565
Practice Address - Country:US
Practice Address - Phone:619-428-2390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19724363AS0400X
CADC28479111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical