Provider Demographics
NPI:1871891192
Name:ESTRADA, PEDRO JR
Entity type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:
Last Name:ESTRADA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 KETTNER BLVD
Mailing Address - Street 2:SUITE 1A4
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1250
Mailing Address - Country:US
Mailing Address - Phone:619-615-0701
Mailing Address - Fax:619-615-0705
Practice Address - Street 1:9445 FARNHAM ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-380-4676
Practice Address - Fax:858-569-2418
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health