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NPI Code Detail

MEDICARE: JAIME E ESTRADA PA-C

MEDICARE: JAIME E ESTRADA PA-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
1363A00000XPhysician Assistant8893918-1206UT

General Provider Information

NPI Number : 1669611935
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAIME E ESTRADA PA-C
Provider Business Mailing Address
First Line : 1275 E FAIRFAX RD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84103-4324
Country : US
Telephone Number : 801-536-3600
Fax Number :
Provider Business Practice Location Address
First Line : 1275 E FAIRFAX RD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84103-4324
Country : US
Telephone Number : 801-536-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2009
Last Update Date : 09/22/2021

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Directions to “ JAIME E ESTRADA PA-C” Practice Location

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