Provider Demographics
NPI:1831806470
Name:ESTRADA, MONTICELLA
Entity type:Individual
Prefix:
First Name:MONTICELLA
Middle Name:
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 1:3549 ESPLANADE SPC 424
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0231
Mailing Address - Country:US
Mailing Address - Phone:530-505-2267
Mailing Address - Fax:
Practice Address - Street 1:3549 ESPLANADE SPC 424
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-0231
Practice Address - Country:US
Practice Address - Phone:530-505-2267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA002978659OtherIHSS