Provider Demographics
NPI:1568977197
Name:ESTRADA, ELECTRA KM (CATC)
Entity Type:Individual
Prefix:
First Name:ELECTRA
Middle Name:KM
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 SONOMA HWY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-4024
Mailing Address - Country:US
Mailing Address - Phone:707-526-3150
Mailing Address - Fax:707-526-3250
Practice Address - Street 1:3555 SONOMA HWY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-4024
Practice Address - Country:US
Practice Address - Phone:707-526-3150
Practice Address - Fax:707-526-3250
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD5375933101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)