Provider Demographics
NPI:1316143308
Name:ESTRADA, PATRICIA C (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:C
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:C
Other - Last Name:ESTRADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4701 WESTBANK EXPY
Mailing Address - Street 2:SUITE #7
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3050
Mailing Address - Country:US
Mailing Address - Phone:504-341-0906
Mailing Address - Fax:504-349-3389
Practice Address - Street 1:4701 WESTBANK EXPY
Practice Address - Street 2:SUITE #7
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3050
Practice Address - Country:US
Practice Address - Phone:504-341-0906
Practice Address - Fax:504-349-3389
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08129R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAE14875OtherUPIN
LA5C660OtherMEDICARE
LA1911402Medicaid
LA721302376OtherPROVIDER TAXONOMIES #
LA08129ROtherLA. STATE LICENSE #