Provider Demographics
NPI:1629339015
Name:ESTRADA PATINO, ANGELA JANET (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:JANET
Last Name:ESTRADA PATINO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:J
Other - Last Name:PATINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:460 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3002
Mailing Address - Country:US
Mailing Address - Phone:760-520-8100
Mailing Address - Fax:
Practice Address - Street 1:460 N ELM ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3002
Practice Address - Country:US
Practice Address - Phone:760-520-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-02
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAPSY31789103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health