Provider Demographics
NPI:1609078286
Name:ESTRADA, JUAN DIEGO (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:DIEGO
Last Name:ESTRADA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 W FLAGLER ST STE 900
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1807
Mailing Address - Country:US
Mailing Address - Phone:786-666-3507
Mailing Address - Fax:305-921-7355
Practice Address - Street 1:66 W FLAGLER ST STE 900
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1807
Practice Address - Country:US
Practice Address - Phone:786-999-3507
Practice Address - Fax:305-921-7355
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434575207R00000X
FLME106081207R00000X
CT045467207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0010900OtherFLORIDA BLUE
FL0016500OtherCENTENE CORPORATION
FLRP039OtherOSCAR HEALTH
FL0001201OtherAETNA HEALTH INC.
FL002670300Medicaid
FL61101OtherHUMANA
FL87726OtherUNITED HEALTHCARE
FL001OtherELEVANCE HEALTH
PA1021894520003Medicaid
PA1021894520001Medicaid