Provider Demographics
NPI:1912798117
Name:ESTRADA, ANITA CHRISTINE (PPS CREDENTIAL)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:CHRISTINE
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:PPS CREDENTIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 S FENIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3426
Mailing Address - Country:US
Mailing Address - Phone:626-533-5474
Mailing Address - Fax:
Practice Address - Street 1:703 S FENIMORE AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3426
Practice Address - Country:US
Practice Address - Phone:626-533-5474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220006000101YS0200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool