Provider Demographics
NPI:1578221024
Name:ESTRERA, DANTE TREYES (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:TREYES
Last Name:ESTRERA
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 HOBSON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605-1827
Mailing Address - Country:US
Mailing Address - Phone:202-425-5105
Mailing Address - Fax:
Practice Address - Street 1:1424 HOBSON AVE
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605-1827
Practice Address - Country:US
Practice Address - Phone:202-425-5105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86369225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty