Provider Demographics
NPI:1801568928
Name:ESTRADA, MELANIE LIZBETH
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:LIZBETH
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 1:1158 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:HEBER
Mailing Address - State:CA
Mailing Address - Zip Code:92249-9777
Mailing Address - Country:US
Mailing Address - Phone:760-960-2576
Mailing Address - Fax:
Practice Address - Street 1:1158 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:HEBER
Practice Address - State:CA
Practice Address - Zip Code:92249-9777
Practice Address - Country:US
Practice Address - Phone:760-960-2576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor