Healthcare Provider Details

I. General information

NPI: 1245118322
Provider Name (Legal Business Name): MR. SEBASTIAN ESTRADA DE SANTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DONATELLO #59
MEXICO CITY MEXICO
03920
MX

IV. Provider business mailing address

DONATELLO #59
MEXICO CITY MEXICO
03920
MX

V. Phone/Fax

Practice location:
  • Phone: 558-330-1090
  • Fax:
Mailing address:
  • Phone:
  • 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: