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General NPI Number Information
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NPI Number | 1184801839
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Entity Type | Organization
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Legal Business Name | DR.JAIME ESTRADA OPTOMETRIC, A.P.C.
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Dates
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Enumeration Date | 01/24/2008
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Last Update Date | 07/22/2010
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Provider Practice Location Address
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Address Line | 4511 GAGE AVE
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City | BELL
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State | CA
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Zip | 90201-1308
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Country | US
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Telephone | 323-560-2786
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Fax | 323-560-2796
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Provider Business Mailing Address
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Address Line | 4511 GAGE AVE
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City | BELL
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State | CA
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Zip | 90201-1308
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Country | US
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Telephone | 323-560-2786
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Fax | 323-560-2796
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Authorized Official
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Title or Position | CONTACT PERSON
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Name | MS. DOROTHY B. HERNANDEZ
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Credential |
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Telephone | 323-560-2786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11129T
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License Number State | CA
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