Provider Demographics
NPI:1053930065
Name:ESTRADA, VERENIS (ND)
Entity type:Individual
Prefix:
First Name:VERENIS
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2144
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-1817
Mailing Address - Country:US
Mailing Address - Phone:971-322-8502
Mailing Address - Fax:
Practice Address - Street 1:5116 NE GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3214
Practice Address - Country:US
Practice Address - Phone:971-322-8502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath