Provider Demographics
NPI:1053175349
Name:ESTRADA, MATTHEW EDWARD (PMHNP)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:EDWARD
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 IMPERIAL HWY APT E312
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-3287
Mailing Address - Country:US
Mailing Address - Phone:323-697-4317
Mailing Address - Fax:
Practice Address - Street 1:10000 IMPERIAL HWY APT E312
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3287
Practice Address - Country:US
Practice Address - Phone:323-697-4317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028920363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health