Provider Demographics
NPI:1356757975
Name:ESTRADA, JANUARIO PAYNOR IV (MD)
Entity type:Individual
Prefix:
First Name:JANUARIO
Middle Name:PAYNOR
Last Name:ESTRADA
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19401 40TH AVE W STE 230
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5675
Mailing Address - Country:US
Mailing Address - Phone:224-595-5388
Mailing Address - Fax:
Practice Address - Street 1:19401 40TH AVE W STE 230
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5675
Practice Address - Country:US
Practice Address - Phone:224-595-5388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60772235207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine