Provider Demographics
NPI:1124136643
Name:ESTRADA GONZALEZ, LUZ (DPM)
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:
Last Name:ESTRADA GONZALEZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6734 SELFRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5739
Mailing Address - Country:US
Mailing Address - Phone:917-767-9004
Mailing Address - Fax:718-649-6426
Practice Address - Street 1:9413 FLATLANDS AVENUE
Practice Address - Street 2:201 E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3741
Practice Address - Country:US
Practice Address - Phone:718-649-6464
Practice Address - Fax:718-649-6426
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004883213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6200631OtherGHI
NY01514323Medicaid
NY6200631OtherGHI
U41842Medicare UPIN