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General NPI Number Information
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NPI Number | 1154746105
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Entity Type | Organization
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Legal Business Name | ESTRADA MEDICAL SERVICES
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Dates
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Enumeration Date | 02/27/2014
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Last Update Date | 02/27/2014
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Provider Practice Location Address
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Address Line | 910 N GALLOWAY AVE SUITE 101
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City | MESQUITE
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State | TX
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Zip | 75149-2409
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Country | US
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Telephone | 972-222-8000
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Fax | 972-329-0042
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Provider Business Mailing Address
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Address Line | 620 N COIT RD SUITE 2150
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City | RICHARDSON
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State | TX
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Zip | 75080-5436
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Country | US
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Telephone | 972-664-0676
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Fax | 972-664-0677
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ROBERTO E ESTRADA
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Credential | MD
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Telephone | 469-951-0287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine
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License Number | H0131
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 457401
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics
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License Number | L4927
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License Number State | TX
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