Provider Demographics
NPI:1629629290
Name:ESTRADA, HECTOR (MS)
Entity Type:Individual
Prefix:MR
First Name:HECTOR
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 GRIFFITH AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1236
Mailing Address - Country:US
Mailing Address - Phone:626-543-5707
Mailing Address - Fax:
Practice Address - Street 1:1343 N GRAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-4043
Practice Address - Country:US
Practice Address - Phone:626-389-9747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst