Provider Demographics
NPI:1528606761
Name:ESTRADA, SERGIO ALVARO
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:ALVARO
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28245 AVENUE CROCKER STE 220
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1201
Mailing Address - Country:US
Mailing Address - Phone:661-254-7086
Mailing Address - Fax:661-254-7108
Practice Address - Street 1:1007 W AVENUE M14 STE P
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1443
Practice Address - Country:US
Practice Address - Phone:661-947-9594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABACB493168103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst