Provider Demographics
NPI:1053541763
Name:ESTIVA, CHERYL (DDS)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:ESTIVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8829 SPECTRUM CENTER BLVD APT 3114
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1481
Mailing Address - Country:US
Mailing Address - Phone:415-652-1119
Mailing Address - Fax:
Practice Address - Street 1:625 W CITRACADO PKWY
Practice Address - Street 2:SUITE #208
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6428
Practice Address - Country:US
Practice Address - Phone:760-745-7070
Practice Address - Fax:760-745-7077
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDING1223G0001X
CA592021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice