Provider Demographics
NPI:1811307184
Name:ESTRADA, JAVIER
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MILLENIUM
Other - Middle Name:
Other - Last Name:CONTRACTORS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8950 SW 74TH CT
Mailing Address - Street 2:STE # 2201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3171
Mailing Address - Country:US
Mailing Address - Phone:305-408-0770
Mailing Address - Fax:305-382-3555
Practice Address - Street 1:8950 SW 74TH CT
Practice Address - Street 2:STE # 2201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-3171
Practice Address - Country:US
Practice Address - Phone:305-408-0770
Practice Address - Fax:305-382-3555
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCGC1505221171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690459900Medicaid