Provider Demographics
NPI:1790775088
Name:ESTRADA, JOSEPH SORIANO (MPAS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:SORIANO
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:MPAS, PA-C
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Mailing Address - Street 1:109 VIEW HALLO WAY
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-3365
Mailing Address - Country:US
Mailing Address - Phone:757-867-5035
Mailing Address - Fax:
Practice Address - Street 1:576 JEFFERSON AVE
Practice Address - Street 2:US ARMY MEDICAL DEPARTMENT ACTIVITY
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-1602
Practice Address - Country:US
Practice Address - Phone:757-314-7887
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
1041741363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant