=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477505394
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLOS R ESTRADA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 06/15/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8608 BIRD RD
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-3216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-551-3200
-----------------------------------------------------
Fax | 305-222-1713
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 BRICKELL KEY BLVD 2406
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33131-3732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-350-2199
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME81544
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------