1326755604 NPI number — CARLOS E ESTRADA

Table of content: REBECA ELIZABETH DAVILA MS (NPI 1043845704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326755604 NPI number — CARLOS E ESTRADA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARLOS E ESTRADA
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:
1326755604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4630 BORDER VILLAGE RD STE 122
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN YSIDRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92173-3121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-409-2014
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLVD RODOLFO SANCHEZ TABOADA 10737 B3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIJUANA
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
22010
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
664-905-9003
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ESTRADA
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
E
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
619-409-2014

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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