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General NPI Number Information
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NPI Number | 1083768295
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Entity Type | Individual
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Provider Name | JOHN J ESTRADA MD
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Gender | Male
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 03/30/2010
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Provider Practice Location Address
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Address Line | 1245 WILSHIRE BLVD SUITE 817
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City | LOS ANGELES
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State | CA
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Zip | 90017-4808
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Country | US
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Telephone | 213-482-1395
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Fax | 213-482-1398
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Provider Business Mailing Address
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Address Line | 1245 WILSHIRE BLVD SUITE 817
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City | LOS ANGELES
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State | CA
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Zip | 90017-4808
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Country | US
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Telephone | 213-482-1395
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Fax | 213-482-1398
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | C27180
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | C27180
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License Number State | CA
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