Provider Demographics
NPI:1689699183
Name:ESTRADA, JUAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:P
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2650 S BRISTOL ST
Mailing Address - Street 2:STE. 101-103
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5751
Mailing Address - Country:US
Mailing Address - Phone:714-754-1444
Mailing Address - Fax:714-754-7009
Practice Address - Street 1:2650 S BRISTOL ST
Practice Address - Street 2:STE. 101-103
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5751
Practice Address - Country:US
Practice Address - Phone:714-754-1444
Practice Address - Fax:714-754-7009
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA73210208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics