Provider Demographics
NPI:1861239436
Name:ESTRADA, VANESA N
Entity type:Individual
Prefix:
First Name:VANESA
Middle Name:N
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 1:9519 OTERO MESA RD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-8771
Mailing Address - Country:US
Mailing Address - Phone:505-948-0431
Mailing Address - Fax:
Practice Address - Street 1:1401 WILLIAM ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-4661
Practice Address - Country:US
Practice Address - Phone:505-768-5450
Practice Address - Fax:505-842-1185
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker