Provider Demographics
NPI:1508973199
Name:ESTRADA, DOREENA A (PA-C)
Entity Type:Individual
Prefix:
First Name:DOREENA
Middle Name:A
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DOREENA
Other - Middle Name:A
Other - Last Name:CASIAS-ESTRADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1599 W TEDMAR AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-1340
Mailing Address - Country:US
Mailing Address - Phone:303-905-9011
Mailing Address - Fax:
Practice Address - Street 1:710 N EUCLID STREET
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801
Practice Address - Country:US
Practice Address - Phone:714-517-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA928363AM0700X
CA55152363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC376408Medicare PIN
COCO305324Medicare PIN