Provider Demographics
NPI:1306950837
Name:ESTRELLADO, JOHNNY F (MD)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:F
Last Name:ESTRELLADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHNNY
Other - Middle Name:F
Other - Last Name:ESTRELLADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:802 E UNIVERSITY DR STE B
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3632
Mailing Address - Country:US
Mailing Address - Phone:956-287-7500
Mailing Address - Fax:956-287-0121
Practice Address - Street 1:802 E UNIVERSITY DR STE B
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3632
Practice Address - Country:US
Practice Address - Phone:956-287-7500
Practice Address - Fax:956-287-0121
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3175208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG80531Medicare UPIN