Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 4301079521 | MI |
Y | 207RH0003X | Hematology & Oncology | A106094 | CA |
NPI | 1013032713 |
---|---|
Provider Name | Dexter T Estrada |
First Address | Fresno, CA 93729-5100 |
Second Address | Fresno, CA 93720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 26/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PO1345504 | RAILROAD MEDICARE (01) | CA |