Provider Demographics
NPI:1447764204
Name:ESTRADA, JAMES C (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:C
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8641 MANDARIN AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-2626
Mailing Address - Country:US
Mailing Address - Phone:909-987-7196
Mailing Address - Fax:
Practice Address - Street 1:8641 MANDARIN AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-2626
Practice Address - Country:US
Practice Address - Phone:909-987-7196
Practice Address - Fax:909-987-7196
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered