Provider Demographics
NPI:1215703376
Name:ESTRADA, KAYLAH DANIELLA SHANELL
Entity type:Individual
Prefix:
First Name:KAYLAH
Middle Name:DANIELLA SHANELL
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 1:3504 W 15TH PL
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4166
Mailing Address - Country:US
Mailing Address - Phone:760-554-3429
Mailing Address - Fax:
Practice Address - Street 1:3504 W 15TH PL
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4166
Practice Address - Country:US
Practice Address - Phone:760-554-3429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst