Provider Demographics
NPI:1487272498
Name:ESTIPONA, DONNA ANALYN ROARING (AMFT)
Entity type:Individual
Prefix:
First Name:DONNA ANALYN
Middle Name:ROARING
Last Name:ESTIPONA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:DONNA ANALYN
Other - Middle Name:ROARING-ESTIPONA
Other - Last Name:SALUTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4904 ADAGIO CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-3201
Mailing Address - Country:US
Mailing Address - Phone:415-713-7982
Mailing Address - Fax:
Practice Address - Street 1:4904 ADAGIO CT
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-3201
Practice Address - Country:US
Practice Address - Phone:415-713-7982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAAMFT139460106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program