Provider Demographics
NPI:1285178681
Name:ESTRADA, SONIA
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PASEO DE LA VICTORIA 4370 INT 418
Mailing Address - Street 2:
Mailing Address - City:JUAREZ
Mailing Address - State:CHIHUAHUA
Mailing Address - Zip Code:32543
Mailing Address - Country:MX
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PASEO DE LA VICTORIA 4370 INT 418
Practice Address - Street 2:
Practice Address - City:JUAREZ
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:32543
Practice Address - Country:MX
Practice Address - Phone:52656-618-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist