Healthcare Provider Details

I. General information

NPI: 1467207449
Provider Name (Legal Business Name): EMMANUEL BUGARIN ESTRADA M.D., M.SC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 12/13/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12 AVENUE DEPARTMENT OF MEDICINE, UNIVERSITY OF MIAMI/JACKSON HEA
MIAMI FL
33136
US

IV. Provider business mailing address

11-12 30TH DR UNIT 412S
ASTORIA NY
11102
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1111
  • Fax:
Mailing address:
  • Phone: 347-752-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: