MEDICARE: ESTRADA MEDICAL CENTER INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	261Q00000X	Clinic/Center
3	261QP2300X	Primary Care Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number	:	1447845995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESTRADA MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	11117 W OKEECHOBEE RD STE 104
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11117 W OKEECHOBEE RD STE 104
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4200
Country	:	US
Telephone Number	:	954-470-0347
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EVELIO VARANY ESTRADA MOLINA
Credential	:	APRN
Telephone Number	:	954-470-0347

Provider Enumeration Date	:	03/06/2021
Last Update Date	:	10/08/2021

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Directions to “ESTRADA MEDICAL CENTER INC ” Practice Location

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