Healthcare Provider Details

I. General information

NPI: 1376528786
Provider Name (Legal Business Name): GUILLERMO M ESTRADA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM STREET N
FARGO ND
58102
US

IV. Provider business mailing address

2101 ELM ST N
FARGO ND
58102-2417
US

V. Phone/Fax

Practice location:
  • Phone: 701-239-3700
  • Fax: 505-368-6431
Mailing address:
  • Phone: 701-239-3700
  • Fax: 505-368-6431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number238372-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: