Provider Demographics
NPI:1275942534
Name:ESTRADA, MATTHEW (LVN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 SAN DIEGO
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7186
Mailing Address - Country:US
Mailing Address - Phone:956-329-9888
Mailing Address - Fax:
Practice Address - Street 1:2602 SAN DIEGO
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-7186
Practice Address - Country:US
Practice Address - Phone:956-329-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214561164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse