1871023465 NPI number — SARATOGA CENTER FOR GUIDANCE/GROWTH MARRIAGE/FAMILY COUNSELING INC

Table of content: MARK-ANTHONY JORDAN ESTRADA RBT (NPI 1235851809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871023465 NPI number — SARATOGA CENTER FOR GUIDANCE/GROWTH MARRIAGE/FAMILY COUNSELING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SARATOGA CENTER FOR GUIDANCE/GROWTH MARRIAGE/FAMILY COUNSELING INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871023465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 SARATOGA AVE STE 212
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95129-3408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
490-824-9804
Provider Business Mailing Address Fax Number:
408-249-9240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 SARATOGA AVE
Provider Second Line Business Practice Location Address:
#212
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95129-3408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
490-824-9804
Provider Business Practice Location Address Fax Number:
408-249-9240
Provider Enumeration Date:
06/15/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
DEAN
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
408-249-8047

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  16638 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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