Healthcare Provider Details

I. General information

NPI: 1821261314
Provider Name (Legal Business Name): ODALYS ESPINOSA ESTRADA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 N UNIVERSITY DR
PLANTATION FL
33322-4111
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 954-748-8200
  • Fax: 855-260-8208
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME106543
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: