Provider Demographics
NPI:1154746105
Name:ESTRADA MEDICAL SERVICES
Entity type:Organization
Organization Name:ESTRADA MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:E
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-951-0287
Mailing Address - Street 1:620 N COIT RD
Mailing Address - Street 2:SUITE 2150
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5436
Mailing Address - Country:US
Mailing Address - Phone:972-664-0676
Mailing Address - Fax:972-664-0677
Practice Address - Street 1:910 N GALLOWAY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2409
Practice Address - Country:US
Practice Address - Phone:972-222-8000
Practice Address - Fax:972-329-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0131207Q00000X
TXL4927208000000X
TX457401363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty