Healthcare Provider Details

I. General information

NPI: 1417487059
Provider Name (Legal Business Name): ESTRADA PEDIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 LAKEVIEW PKWY # 400
ROWLETT TX
75088-4177
US

IV. Provider business mailing address

3705 LAKEVIEW PKWY # 400
ROWLETT TX
75088-4177
US

V. Phone/Fax

Practice location:
  • Phone: 972-412-4813
  • Fax:
Mailing address:
  • Phone: 972-412-4813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL4927
License Number StateTX

VIII. Authorized Official

Name: ROBERTO E ESTRADA
Title or Position: OWNER
Credential: MD
Phone: 972-412-4813