Provider Demographics
NPI:1992985220
Name:ESTRADA, SHIGRID ROSE MARIE MANTALABA
Entity type:Individual
Prefix:MS
First Name:SHIGRID ROSE MARIE
Middle Name:MANTALABA
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 1:201 WEST CALIFORNIA AVE
Mailing Address - Street 2:APRTAMENT 804
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086
Mailing Address - Country:US
Mailing Address - Phone:408-824-8036
Mailing Address - Fax:
Practice Address - Street 1:201 W CALIFORNIA AVE
Practice Address - Street 2:APARTMENT 804
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-5063
Practice Address - Country:US
Practice Address - Phone:408-824-8036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-03
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12944225X00000X
CA9965225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist