Provider Demographics
NPI:1871959098
Name:ESTRADA, MAYRA JANE (MA,)
Entity type:Individual
Prefix:MS
First Name:MAYRA
Middle Name:JANE
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:MA,
Other - Prefix:MS
Other - First Name:MAYRA
Other - Middle Name:JUDITH
Other - Last Name:MURILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:13968 DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-3147
Mailing Address - Country:US
Mailing Address - Phone:657-263-4362
Mailing Address - Fax:
Practice Address - Street 1:26137 LA PAZ RD STE 230
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5337
Practice Address - Country:US
Practice Address - Phone:949-595-8610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherMEDICAL