Provider Demographics
NPI:1306454566
Name:ESTRADA SERRANO, JULIO ELVIN (MD)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:ELVIN
Last Name:ESTRADA SERRANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 7236
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-9788
Mailing Address - Country:US
Mailing Address - Phone:787-326-2060
Mailing Address - Fax:
Practice Address - Street 1:10 CALLE CRISTOBAL COLON
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767-3332
Practice Address - Country:US
Practice Address - Phone:787-893-8204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR021883208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR021883OtherPUERTO RICO MEDICAL DISCIPLINE AND LICENSURE BOARD