Healthcare Provider Details

I. General information

NPI: 1073843991
Provider Name (Legal Business Name): CARLOS ALEXIS ESTRELLA GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 OAKLEY SEAVER DR STE C
CLERMONT FL
34711-1925
US

IV. Provider business mailing address

1804 OAKLEY SEAVER DR STE C
CLERMONT FL
34711-1925
US

V. Phone/Fax

Practice location:
  • Phone: 352-242-1021
  • Fax: 352-242-1104
Mailing address:
  • Phone: 352-242-1021
  • Fax: 352-242-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME105963
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: