Provider Demographics
NPI:1306917661
Name:ESTRADA, JAIME E (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:E
Last Name:ESTRADA
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 1:1001 E BIRCH ST, HWY 98
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-9759
Mailing Address - Country:US
Mailing Address - Phone:760-890-5593
Mailing Address - Fax:760-545-0251
Practice Address - Street 1:1001 E. BIRCH ST, HWY 98
Practice Address - Street 2:SUITE 1
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-9759
Practice Address - Country:US
Practice Address - Phone:760-890-5593
Practice Address - Fax:760-545-0251
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA067747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA067747OtherMEDICAL LICENCE
CAW13536BOtherMEDICARE GROUP NUMBER
CA00A677470Medicaid
CAGR0066312Medicaid
CACC6635Medicare PIN
CAWA67747GMedicare PIN
CAW13536BOtherMEDICARE GROUP NUMBER
CAW13536BMedicare PIN