Provider Demographics
NPI:1952815094
Name:ESTRADA, ROBERT ANTHONY (CATC-I 2011943 I)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANTHONY
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:CATC-I 2011943 I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7426 CHERRY AVE STE 210-705
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4221
Mailing Address - Country:US
Mailing Address - Phone:562-479-9523
Mailing Address - Fax:999-999-9999
Practice Address - Street 1:755 E GILBERT ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-9734
Practice Address - Country:US
Practice Address - Phone:909-462-8244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2011943-I101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)