Healthcare Provider Details

I. General information

NPI: 1609078286
Provider Name (Legal Business Name): JUAN DIEGO ESTRADA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 NW 36TH ST STE 501
DORAL FL
33166-6688
US

IV. Provider business mailing address

8600 NW 36TH ST STE 501
DORAL FL
33166-6688
US

V. Phone/Fax

Practice location:
  • Phone: 305-831-2358
  • Fax: 645-654-0920
Mailing address:
  • Phone: 305-831-2358
  • Fax: 645-654-0920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME106081
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD434575
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number045467
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: