Provider Demographics
NPI:1477505394
Name:ESTRADA, CARLOS R (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:R
Last Name:ESTRADA
Suffix:
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 1:901 BRICKELL KEY BLVD
Mailing Address - Street 2:2406
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3732
Mailing Address - Country:US
Mailing Address - Phone:305-350-2199
Mailing Address - Fax:
Practice Address - Street 1:8608 BIRD RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3216
Practice Address - Country:US
Practice Address - Phone:305-551-3200
Practice Address - Fax:305-222-1713
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81544207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA75582Medicare UPIN