Provider Demographics
NPI:1770862864
Name:ESTRADA, MIRIAM JEANETTE
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:JEANETTE
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 COMMUNITY PKWY
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-2816
Mailing Address - Country:US
Mailing Address - Phone:831-801-6692
Mailing Address - Fax:
Practice Address - Street 1:1131 COMMUNITY PKWY
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-2816
Practice Address - Country:US
Practice Address - Phone:831-801-6692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No101Y00000XBehavioral Health & Social Service ProvidersCounselor