Provider Demographics
NPI:1881453801
Name:ESTRADA, ANNA VICTORIA I
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:VICTORIA
Last Name:ESTRADA
Suffix:I
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 1:1617 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-8531
Mailing Address - Country:US
Mailing Address - Phone:386-717-0901
Mailing Address - Fax:
Practice Address - Street 1:1617 OAK AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-8531
Practice Address - Country:US
Practice Address - Phone:386-717-0901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-328871106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician