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1205240504 NPI number — MICHAEL ESTRADA

NPI Number: 1205240504
Health Care Provider/Practitioner: MICHAEL ESTRADA

Information about “1205240504” NPI (MICHAEL ESTRADA) exists in 1205240504 in HTML format HTML  |  1205240504 in plain Text format TXT  |  1205240504 in PDF (Portable Document Format) PDF  |  1205240504 in an XML format XML  formats.

NPI Number : 1205240504 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205240504",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ESTRADA",
    "FirstName": "MICHAEL",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "8211 WOLVERINE DR NW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ALBUQUERQUE",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "87120-5269",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "505-306-9031",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8211 WOLVERINE DR NW",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ALBUQUERQUE",
    "PracticeLocationAddressStateName": "NM",
    "PracticeLocationAddressPostalCode": "87120-5269",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "505-306-9031",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/13/2014",
    "LastUpdateDate": "09/12/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "SWB-2023-0428",
          "LicenseNumberStateCode": "NM",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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