Healthcare Provider Details

I. General information

NPI: 1841556115
Provider Name (Legal Business Name): TOMAS ESTRADA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6907 LONGLEAF LN
AMARILLO TX
79124-3920
US

IV. Provider business mailing address

6907 LONGLEAF LN
AMARILLO TX
79124-3920
US

V. Phone/Fax

Practice location:
  • Phone: 806-316-4239
  • Fax:
Mailing address:
  • Phone: 806-316-4239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number718883
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: