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General NPI Number Information
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NPI Number | 1417487059
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Entity Type | Organization
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Legal Business Name | ESTRADA PEDIATRIC CENTER
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Dates
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Enumeration Date | 06/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3705 LAKEVIEW PKWY # 400
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City | ROWLETT
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State | TX
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Zip | 75088-4177
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Country | US
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Telephone | 972-412-4813
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Fax |
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Provider Business Mailing Address
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Address Line | 3705 LAKEVIEW PKWY # 400
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City | ROWLETT
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State | TX
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Zip | 75088-4177
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Country | US
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Telephone | 972-412-4813
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERTO E ESTRADA
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Credential | MD
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Telephone | 972-412-4813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | L4927
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License Number State | TX
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