Provider Demographics
NPI:1750414009
Name:ESTRADA-FEDERIZO, ELIZABETH SUGAPONG (MD,)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUGAPONG
Last Name:ESTRADA-FEDERIZO
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:PALENZUELA
Other - Last Name:SUGAPONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43244 FANCHON AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-1357
Mailing Address - Country:US
Mailing Address - Phone:661-940-9321
Mailing Address - Fax:
Practice Address - Street 1:38350 40TH ST E
Practice Address - Street 2:SUITE 100
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-3075
Practice Address - Country:US
Practice Address - Phone:661-272-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA051630261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health