Provider Demographics
NPI:1982214656
Name:ESTRADA, DESTINY DANIELLE
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:DANIELLE
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 1:1140 RIDGE CREEK ESTATES WAY
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-9244
Mailing Address - Country:US
Mailing Address - Phone:559-419-3999
Mailing Address - Fax:
Practice Address - Street 1:1310 STROUD AVE
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-1000
Practice Address - Country:US
Practice Address - Phone:559-897-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool