Provider Demographics
NPI:1710743109
Name:ESTRADA, VANESSA (ND, LMT, CNA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:ND, LMT, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8728 LAROQUE RUN DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-1991
Mailing Address - Country:US
Mailing Address - Phone:540-538-8124
Mailing Address - Fax:
Practice Address - Street 1:8728 LAROQUE RUN DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-1991
Practice Address - Country:US
Practice Address - Phone:540-538-8124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401135304376K00000X
VA0019019040225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No376K00000XNursing Service Related ProvidersNurse's Aide