1104123454 NPI number — VALENTIN ESTRADA M.D P.A

Table of content: DR. EILEEN LOUISE POUPORE NP (NPI 1639158223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104123454 NPI number — VALENTIN ESTRADA M.D P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALENTIN ESTRADA M.D P.A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104123454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12260 SW 8 STREET
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33184-1551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-360-6057
Provider Business Mailing Address Fax Number:
786-360-6115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12260 SW 8TH ST
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33184-1551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-360-6057
Provider Business Practice Location Address Fax Number:
786-360-6115
Provider Enumeration Date:
02/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ESTRADA
Authorized Official First Name:
VALENTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
786-360-6057

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  ME96866 , 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: 277863700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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