Provider Demographics
NPI:1548786072
Name:TOBE ESTRADA, ANGELA DENISE
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DENISE
Last Name:TOBE 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 1:2104 SLIGHS AVE APT A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-1197
Mailing Address - Country:US
Mailing Address - Phone:803-542-8840
Mailing Address - Fax:
Practice Address - Street 1:26 OFFICE PARK CT STE D1
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5954
Practice Address - Country:US
Practice Address - Phone:803-757-5264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information