Provider Demographics
NPI:1174663686
Name:ESTRADA, EVELYN S (MD)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:S
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S SCHEUBER RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-8877
Mailing Address - Country:US
Mailing Address - Phone:360-330-8950
Mailing Address - Fax:360-330-8955
Practice Address - Street 1:1000 S SCHEUBER RD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-8877
Practice Address - Country:US
Practice Address - Phone:360-330-8950
Practice Address - Fax:360-330-8955
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017177207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology