Provider Demographics
NPI:1164636353
Name:ESTRADA, JAIME OBED (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:OBED
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13125 EAST FWY
Mailing Address - Street 2:B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-5803
Mailing Address - Country:US
Mailing Address - Phone:713-645-4362
Mailing Address - Fax:
Practice Address - Street 1:5631 TELEPHONE RD
Practice Address - Street 2:STE. B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-4485
Practice Address - Country:US
Practice Address - Phone:713-645-4362
Practice Address - Fax:713-645-4600
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03505363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant