Provider Demographics
NPI:1528205457
Name:ESTRADA, GINA MARIA (LVN)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIA
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIA
Other - Last Name:LEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:4342 HEDDA ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1135
Mailing Address - Country:US
Mailing Address - Phone:562-920-6647
Mailing Address - Fax:
Practice Address - Street 1:4342 HEDDA ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1135
Practice Address - Country:US
Practice Address - Phone:562-920-6647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA173785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA173785OtherLVN