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NPI Code Detail

MEDICARE: DR.JAIME ESTRADA OPTOMETRIC, A.P.C.

MEDICARE: DR.JAIME ESTRADA OPTOMETRIC, A.P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist11129TCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184801839
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR.JAIME ESTRADA OPTOMETRIC, A.P.C.
Provider Business Mailing Address
First Line : 4511 GAGE AVE
Second Line :
City : BELL
State : CA
Zip : 90201-1308
Country : US
Telephone Number : 323-560-2786
Fax Number : 323-560-2796
Provider Business Practice Location Address
First Line : 4511 GAGE AVE
Second Line :
City : BELL
State : CA
Zip : 90201-1308
Country : US
Telephone Number : 323-560-2786
Fax Number : 323-560-2796
Authorized Official
Title or Position : CONTACT PERSON
Name : MS. DOROTHY B. HERNANDEZ
Credential :
Telephone Number : 323-560-2786
Provider Enumeration Date : 01/24/2008
Last Update Date : 07/22/2010

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