Provider Demographics
NPI:1609078286
Name:ESTRADA, JUAN DIEGO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:DIEGO
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 NW 33RD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1937
Mailing Address - Country:US
Mailing Address - Phone:305-921-7619
Mailing Address - Fax:305-921-7355
Practice Address - Street 1:2000 NW 87TH AVE STE 101&102
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2654
Practice Address - Country:US
Practice Address - Phone:305-921-7619
Practice Address - Fax:305-921-7355
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045467207R00000X
PAMD434575207R00000X
FLME106081207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021894520003Medicaid
PA1021894520001Medicaid
FL002670300Medicaid
PA3723949000OtherINDEPENDENCE
PA1021894520002Medicaid
PA30068078OtherKEYSTONE MERCY HEALTH PLAN
PA2088879OtherHIGHMARK BLUE SHIELD
PA3723949000OtherINDEPENDENCE
PA1021894520003Medicaid
PA1021894520001Medicaid