Provider Demographics
NPI:1215136411
Name:TRINIDAD, ESTRELLA CALLEJO (DMD)
Entity type:Individual
Prefix:
First Name:ESTRELLA
Middle Name:CALLEJO
Last Name:TRINIDAD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4364 THORNTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4828
Mailing Address - Country:US
Mailing Address - Phone:510-793-8121
Mailing Address - Fax:510-793-8210
Practice Address - Street 1:4364 THORNTON AVENUE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4828
Practice Address - Country:US
Practice Address - Phone:510-793-8121
Practice Address - Fax:510-793-8210
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA450451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABU5045 01Medicaid