Provider Demographics
NPI:1134448368
Name:ESTRADA, MAYREN LARA (LVN)
Entity type:Individual
Prefix:
First Name:MAYREN
Middle Name:LARA
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 LEMON WAY
Mailing Address - Street 2:#24
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93015-1125
Mailing Address - Country:US
Mailing Address - Phone:805-765-9050
Mailing Address - Fax:805-653-0567
Practice Address - Street 1:300 HILLMONT AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1651
Practice Address - Country:US
Practice Address - Phone:805-765-9050
Practice Address - Fax:805-653-0567
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN238133164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse