Provider Demographics
NPI:1568204055
Name:ESTRADA GONZALEZ, KAREN YISHEY
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:YISHEY
Last Name:ESTRADA GONZALEZ
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 1:930 N MESA DR UNIT 2062
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-4332
Mailing Address - Country:US
Mailing Address - Phone:505-544-9137
Mailing Address - Fax:
Practice Address - Street 1:930 N MESA DR UNIT 2062
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-4332
Practice Address - Country:US
Practice Address - Phone:505-544-9137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZT077977183700000X
171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
No183700000XPharmacy Service ProvidersPharmacy Technician