Provider Demographics
NPI:1841061470
Name:ESTRADA, ROMELDA CAPITLY (NP)
Entity type:Individual
Prefix:
First Name:ROMELDA
Middle Name:CAPITLY
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEL
Other - Middle Name:
Other - Last Name:CAPITLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:118 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-3364
Mailing Address - Country:US
Mailing Address - Phone:626-914-3871
Mailing Address - Fax:626-914-3871
Practice Address - Street 1:118 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3364
Practice Address - Country:US
Practice Address - Phone:626-914-3871
Practice Address - Fax:626-914-3871
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95027012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily