Provider Demographics
NPI:1063287209
Name:ESTRADA, NATALY (BCBA)
Entity type:Individual
Prefix:
First Name:NATALY
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11173 PIGGOTT DR
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3909
Mailing Address - Country:US
Mailing Address - Phone:310-486-2943
Mailing Address - Fax:
Practice Address - Street 1:5800 HANNUM AVE STE B
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6525
Practice Address - Country:US
Practice Address - Phone:424-362-8405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-23-64681103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst