Provider Demographics
NPI:1346697166
Name:ESTRADA, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20919 BIRNAM WOOD BLVD
Mailing Address - Street 2:APT.627
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-1867
Mailing Address - Country:US
Mailing Address - Phone:832-613-7417
Mailing Address - Fax:
Practice Address - Street 1:20919 BIRNAM WOOD BLVD
Practice Address - Street 2:APT.627
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-1867
Practice Address - Country:US
Practice Address - Phone:832-613-7417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-22
Last Update Date:2016-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker