Provider Demographics
NPI:1205334653
Name:ESTRADA-STOLPE, DIANA (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:ESTRADA-STOLPE
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 SCRUB JAY CT
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-2526
Mailing Address - Country:US
Mailing Address - Phone:619-818-8495
Mailing Address - Fax:
Practice Address - Street 1:3405 MARRON RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4673
Practice Address - Country:US
Practice Address - Phone:619-818-8495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist