Provider Demographics
NPI:1487872164
Name:ESTRADA, LILLIAN ARLENE
Entity type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:ARLENE
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LILLIAN
Other - Middle Name:ARLENE
Other - Last Name:MELENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15450 LEFFINGWELL RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-3207
Mailing Address - Country:US
Mailing Address - Phone:562-665-9267
Mailing Address - Fax:
Practice Address - Street 1:3125 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-4932
Practice Address - Country:US
Practice Address - Phone:562-987-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330355130Medicaid