Provider Demographics
NPI:1477763670
Name:VICTOR A ESTRADA MD PA
Entity Type:Organization
Organization Name:VICTOR A ESTRADA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-490-2051
Mailing Address - Street 1:14615 SAN PEDRO
Mailing Address - Street 2:# 250
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4316
Mailing Address - Country:US
Mailing Address - Phone:210-490-2051
Mailing Address - Fax:210-490-6758
Practice Address - Street 1:14615 SAN PEDRO
Practice Address - Street 2:# 250
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4316
Practice Address - Country:US
Practice Address - Phone:210-490-2051
Practice Address - Fax:210-490-6758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8095174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120515505Medicaid
TX120515505Medicaid
TX00201VMedicare PIN