Provider Demographics
NPI:1508013681
Name:ESTRADA, ROSA NELY (MA LMFT)
Entity Type:Individual
Prefix:
First Name:ROSA NELY
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 CHAMBERS RD STE 125
Mailing Address - Street 2:2525 CHAMBERS RD STE 100
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6962
Mailing Address - Country:US
Mailing Address - Phone:949-463-4949
Mailing Address - Fax:
Practice Address - Street 1:2522 CHAMBERS RD STE 125
Practice Address - Street 2:2522 CHAMBERS RD STE 100
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6962
Practice Address - Country:US
Practice Address - Phone:949-463-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78860106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist