Provider Demographics
NPI:1376818799
Name:ESTRADA, JOSE EDUARDO
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:EDUARDO
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 EL PASEO
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-4208
Mailing Address - Country:US
Mailing Address - Phone:626-274-4476
Mailing Address - Fax:626-442-1144
Practice Address - Street 1:2000 TYLER AVE
Practice Address - Street 2:
Practice Address - City:S EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-3543
Practice Address - Country:US
Practice Address - Phone:626-442-1400
Practice Address - Fax:626-442-1144
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor