1841807815 NPI number — GRETCHEN ESTRADA MD

Table of content: GRETCHEN ESTRADA MD (NPI 1841807815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841807815 NPI number — GRETCHEN ESTRADA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESTRADA
Provider First Name:
GRETCHEN
Provider Middle Name:
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:
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:
1841807815
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB SAGRADO CORAZON
Provider Second Line Business Mailing Address:
1755 CALLE SANTA PRAXEDES
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-639-3721
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MEMORIAL HEALTHCARE SYSTEM
Provider Second Line Business Practice Location Address:
7800 SHERIDAN ST
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33024-2536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
195-496-2965
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/24/2020

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 22665 . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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