Provider Demographics
NPI:1699489427
Name:ESTRADA, ALONDRA
Entity type:Individual
Prefix:
First Name:ALONDRA
Middle Name:
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 1:3255 E AVENUE R SPC 68
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-5653
Mailing Address - Country:US
Mailing Address - Phone:661-478-2049
Mailing Address - Fax:
Practice Address - Street 1:1331 W AVENUE J STE 206
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2954
Practice Address - Country:US
Practice Address - Phone:661-434-3056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1471850622101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY5036707OtherDRUG AND ALCOHOL RECOVERY SERVICES