Provider Demographics
NPI:1417163239
Name:ESTRADA VIERA, ABIUD (0375P)
Entity Type:Individual
Prefix:
First Name:ABIUD
Middle Name:
Last Name:ESTRADA VIERA
Suffix:
Gender:M
Credentials:0375P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 30 BOX 33020
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-9729
Mailing Address - Country:US
Mailing Address - Phone:787-218-5827
Mailing Address - Fax:787-736-8319
Practice Address - Street 1:CALLE JOSE DE DIEGO 111
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-9729
Practice Address - Country:US
Practice Address - Phone:787-218-5827
Practice Address - Fax:787-736-8319
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0375P146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic