Provider Demographics
NPI:1003856386
Name:ESTRADA, ERNEST VII (PA)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:ESTRADA
Suffix:VII
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 861477
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90086-1477
Mailing Address - Country:US
Mailing Address - Phone:800-749-4560
Mailing Address - Fax:405-749-4561
Practice Address - Street 1:501 S BUENA VISTA ST
Practice Address - Street 2:EM DEPT.
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4809
Practice Address - Country:US
Practice Address - Phone:818-843-5111
Practice Address - Fax:405-749-4561
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12318363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1019034OtherNCCPA
CAPA12318Medicaid
ME0566539OtherDEA LICENSE
CAPA12318Medicaid
S98808Medicare UPIN