Provider Demographics
NPI:1215104351
Name:ESTRADA, ROBIN D
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:D
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 COLONIAL COMMONS CT STE 231
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-2200
Mailing Address - Country:US
Mailing Address - Phone:803-289-5437
Mailing Address - Fax:803-289-5440
Practice Address - Street 1:1228 COLONIAL COMMONS CT STE 231
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2200
Practice Address - Country:US
Practice Address - Phone:803-289-5437
Practice Address - Fax:803-289-5440
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC607363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4668Medicaid