Provider Demographics
NPI:1952646093
Name:ESTRADA, NINYETTE ALICIA-CARRILLO
Entity Type:Individual
Prefix:
First Name:NINYETTE
Middle Name:ALICIA-CARRILLO
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 1:760 VIA LATA STE 250
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3977
Mailing Address - Country:US
Mailing Address - Phone:909-872-0223
Mailing Address - Fax:
Practice Address - Street 1:760 VIA LATA STE 250
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3977
Practice Address - Country:US
Practice Address - Phone:909-872-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health