Provider Demographics
NPI:1508510157
Name:ESTRADA DE JESUS, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:ESTRADA DE JESUS
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:STREET 19 L7
Mailing Address - Street 2:MAGNOLIA GARDENS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-2650
Mailing Address - Country:US
Mailing Address - Phone:787-800-3163
Mailing Address - Fax:
Practice Address - Street 1:L7 CALLE 19
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-2650
Practice Address - Country:US
Practice Address - Phone:787-800-3163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4612497347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker