Healthcare Provider Details

I. General information

NPI: 1881082733
Provider Name (Legal Business Name): RAYMOND ESTRADA JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 S GRAND CANYON DR APT 1115
LAS VEGAS NV
89147-7115
US

IV. Provider business mailing address

4370 S GRAND CANYON DR APT 1115
LAS VEGAS NV
89147-7115
US

V. Phone/Fax

Practice location:
  • Phone: 702-491-4123
  • Fax:
Mailing address:
  • Phone: 702-491-4123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN35186
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: