Provider Demographics
NPI:1003655655
Name:ESTRADA MESA, ELIZABETH (MD, DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ESTRADA MESA
Suffix:
Gender:F
Credentials:MD, DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16331 SW 96TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-5834
Mailing Address - Country:US
Mailing Address - Phone:786-612-4877
Mailing Address - Fax:
Practice Address - Street 1:2500 SW 75TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2805
Practice Address - Country:US
Practice Address - Phone:305-264-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL39946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty