Provider Demographics
NPI:1003367251
Name:ESTRADA, CARLOS I
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:ESTRADA
Suffix:I
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 1:13205 SW 137TH AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5334
Mailing Address - Country:US
Mailing Address - Phone:786-227-6258
Mailing Address - Fax:786-429-1586
Practice Address - Street 1:13205 SW 137TH AVE STE 120
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5334
Practice Address - Country:US
Practice Address - Phone:786-227-6258
Practice Address - Fax:786-429-1586
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator