Provider Demographics
NPI:1962413641
Name:ESTRADA, MARIBEN CRISTINA C (MD)
Entity type:Individual
Prefix:
First Name:MARIBEN CRISTINA
Middle Name:C
Last Name:ESTRADA
Suffix:
Gender:F
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:PO BOX 5299
Mailing Address - Street 2:MS: 820-5-PCO
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0299
Mailing Address - Country:US
Mailing Address - Phone:253-459-8231
Mailing Address - Fax:
Practice Address - Street 1:2202 S CEDAR ST STE 300
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2318
Practice Address - Country:US
Practice Address - Phone:253-301-5280
Practice Address - Fax:253-627-4608
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042378207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8931691OtherCRIME VICTIMS
WAP00125955OtherRAILROAD
WA8379851Medicaid
WA178073OtherL & I
WA0205417OtherL & I
WA8931691OtherCRIME VICTIMS
I00141Medicare UPIN
WAG8858257Medicare PIN