Provider Demographics
NPI:1609463876
Name:ESTRADA, GABRIEL (LMT)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 N OLEANDER ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-1674
Mailing Address - Country:US
Mailing Address - Phone:480-343-4257
Mailing Address - Fax:
Practice Address - Street 1:1926 N OLEANDER ST
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-1674
Practice Address - Country:US
Practice Address - Phone:480-343-4257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-23269225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist