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General NPI Number Information
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NPI Number | 1043032998
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Entity Type | Individual
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Provider Name | GENCO M ESTRADA VINAJERA
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Gender | Male
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 2989 OLD CUTLER ROAD
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City | MIAMI
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State | FL
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Zip | 33189
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Country | US
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Telephone | 786-596-3876
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 198054
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City | ATLANTA
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State | GA
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Zip | 30384-8054
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APRN11036264
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License Number State | FL
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