Provider Demographics
NPI:1417020157
Name:ESTRADA, CAROLYN NELL (MA, MT-BC, NMT FELLO)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:NELL
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:MA, MT-BC, NMT FELLO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 E STATE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5049
Mailing Address - Country:US
Mailing Address - Phone:602-402-9763
Mailing Address - Fax:
Practice Address - Street 1:917 E STATE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5049
Practice Address - Country:US
Practice Address - Phone:602-402-9763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ02750174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist