Basic Information
| Provider Information | |||||||||
| NPI: | 1831774173 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESTRADA SANCHEZ | ||||||||
| FirstName: | DENISSE | ||||||||
| MiddleName: | |||||||||
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| Credential: | RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 877 EMBARCADERO DR STE 1 | ||||||||
| Address2: | |||||||||
| City: | EL DORADO HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957621400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166936469 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 877 EMBARCADERO DR STE 1 | ||||||||
| Address2: | |||||||||
| City: | EL DORADO HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957621400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166936469 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2021 | ||||||||
| LastUpdateDate: | 03/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | F5148383 | 05 | CA | MEDICAID |