1073539995 NPI number — CHRISTINA ESTRADA LEE MD

Table of content: CHRISTINA ESTRADA LEE MD (NPI 1073539995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073539995 NPI number — CHRISTINA ESTRADA LEE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
CHRISTINA
Provider Middle Name:
ESTRADA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESTRADA
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073539995
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4033 TAMPA ROAD, SUITE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLDSMAR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34677-3224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-854-2003
Provider Business Mailing Address Fax Number:
813-855-2367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10729 QUEENS TOWN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERVIEW
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33579-7186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-672-3497
Provider Business Practice Location Address Fax Number:
813-741-2418
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  ME 84549 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2647231 00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 264723100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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