Provider Demographics
NPI:1306263785
Name:ESTONACTOC, GEORGE VALERA (PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:VALERA
Last Name:ESTONACTOC
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:CY
Other - Middle Name:VALERA
Other - Last Name:ESTONACTOC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:28292 EL SUR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4422
Mailing Address - Country:US
Mailing Address - Phone:949-412-7178
Mailing Address - Fax:
Practice Address - Street 1:28292 EL SUR
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4422
Practice Address - Country:US
Practice Address - Phone:949-412-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25631103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily