Healthcare Provider Details

I. General information

NPI: 1033425004
Provider Name (Legal Business Name): JUVIANEE IBRAHIM ESTRADA-VERAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4954 N PALMER RD BLDG 19 MCC, 3RD FLOOR, ROOM 3186
BETHESDA MD
20889-5630
US

IV. Provider business mailing address

4954 N PALMER RD BLDG 19 MCC, 3RD FLOOR, ROOM 3186
BETHESDA MD
20889-5630
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4951
  • Fax: 301-319-4757
Mailing address:
  • Phone: 301-295-4951
  • Fax: 301-319-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0082582
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207SG0207X
TaxonomyMedical Biochemical Genetics
License NumberD0082582
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: