Healthcare Provider Details

I. General information

NPI: 1144143660
Provider Name (Legal Business Name): DR. JUAN ESTRADA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 NE 22ND WAY APT 303
FORT LAUDERDALE FL
33308-2645
US

IV. Provider business mailing address

5700 NE 22ND WAY APT 303
FORT LAUDERDALE FL
33308-2645
US

V. Phone/Fax

Practice location:
  • Phone: 754-233-1014
  • Fax:
Mailing address:
  • Phone: 754-233-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY13041
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: