Healthcare Provider Details

I. General information

NPI: 1669638631
Provider Name (Legal Business Name): JOEL ESTRADA M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 185 KM 12.6 BARRIO CEDROS
CAROLINA PR
00985
US

IV. Provider business mailing address

353 CAMINO LOS LIRIOS URB SABANERA DEL RIO
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-776-2492
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number3901
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: