Provider Demographics
NPI:1558896050
Name:ESTRADA, LUZ
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:
Last Name: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 1:9461 SW 30TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3111
Mailing Address - Country:US
Mailing Address - Phone:786-493-5696
Mailing Address - Fax:
Practice Address - Street 1:9461 SW 30TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3111
Practice Address - Country:US
Practice Address - Phone:786-493-5696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-22
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician