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General NPI Number Information
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NPI Number | 1306454566
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Entity Type | Individual
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Provider Name | JULIO ELVIN ESTRADA SERRANO MD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 10 CALLE CRISTOBAL COLON
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City | YABUCOA
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State | PR
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Zip | 00767-3332
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Country | US
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Telephone | 787-893-8204
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Fax |
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Provider Business Mailing Address
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Address Line | HC 2 BOX 7236
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City | LAS PIEDRAS
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State | PR
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Zip | 00771-9788
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Country | US
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Telephone | 787-326-2060
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 021883
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License Number State | PR
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