Provider Demographics
NPI:1417506395
Name:RIECO ESTRADA, INELDIS
Entity Type:Individual
Prefix:
First Name:INELDIS
Middle Name:
Last Name:RIECO 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 1:120 ROYAL PALM RD APT 109
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4610
Mailing Address - Country:US
Mailing Address - Phone:305-345-1502
Mailing Address - Fax:
Practice Address - Street 1:120 ROYAL PALM RD APT 109
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-4610
Practice Address - Country:US
Practice Address - Phone:305-345-1502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care