Provider Demographics
NPI:1376233510
Name:ESTRADA, MARLENE I
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:ESTRADA
Suffix:I
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 1:1000 S FREMONT AVE UNIT 20
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-8840
Mailing Address - Country:US
Mailing Address - Phone:626-759-9154
Mailing Address - Fax:844-845-1077
Practice Address - Street 1:1000 S FREMONT AVE UNIT 20
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8840
Practice Address - Country:US
Practice Address - Phone:626-759-9154
Practice Address - Fax:844-845-1077
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician