Healthcare Provider Details

I. General information

NPI: 1801200480
Provider Name (Legal Business Name): VICTOR A ESTRADA MD CHTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 S EASTERN AVE SUITE A
LAS VEGAS NV
89119-7851
US

IV. Provider business mailing address

PO BOX 202110
AUSTIN TX
78720-2110
US

V. Phone/Fax

Practice location:
  • Phone: 702-735-1556
  • Fax: 702-737-7495
Mailing address:
  • Phone: 512-732-2774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBYN WOLF
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 512-732-2774