Healthcare Provider Details

I. General information

NPI: 1548786072
Provider Name (Legal Business Name): ANGELA DENISE TOBE ESTRADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 08/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 OFFICE PARK CT STE D1
COLUMBIA SC
29223-5954
US

IV. Provider business mailing address

2104 SLIGHS AVE APT A
COLUMBIA SC
29204-1197
US

V. Phone/Fax

Practice location:
  • Phone: 803-757-5264
  • Fax:
Mailing address:
  • Phone: 803-542-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: