Provider Demographics
NPI:1134923410
Name:ESTRADA, IRIS ALEJANDRA
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:ALEJANDRA
Last Name:ESTRADA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 W WARLOW DR STE A
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-2527
Mailing Address - Country:US
Mailing Address - Phone:307-363-4019
Mailing Address - Fax:
Practice Address - Street 1:1890 W WARLOW DR STE A
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-2527
Practice Address - Country:US
Practice Address - Phone:307-363-4019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty