Provider Demographics
NPI:1477972990
Name:ESTRADA, DENISE MARIE (LAC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 ARMACOST AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2716
Mailing Address - Country:US
Mailing Address - Phone:310-613-0800
Mailing Address - Fax:
Practice Address - Street 1:4136 WOODRUFF AVENUE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713
Practice Address - Country:US
Practice Address - Phone:562-421-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-11
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No174H00000XOther Service ProvidersHealth Educator