Provider Demographics
NPI:1649057357
Name:ESTRADA, JESSE
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 E ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-2024
Mailing Address - Country:US
Mailing Address - Phone:559-268-6261
Mailing Address - Fax:559-268-7516
Practice Address - Street 1:1235 E ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-2024
Practice Address - Country:US
Practice Address - Phone:559-268-6261
Practice Address - Fax:559-268-7518
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23358101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)