Provider Demographics
NPI:1689811762
Name:ESTRADA, CECILIA (776006066)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:776006066
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10131 MCNERNEY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6205
Mailing Address - Country:US
Mailing Address - Phone:213-977-4901
Mailing Address - Fax:
Practice Address - Street 1:10131 MCNERNEY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6205
Practice Address - Country:US
Practice Address - Phone:213-977-4901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA776006066126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Multi-Specialty