Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | DN13946 | FL |
Y | 1223G0001X | General Practice | DN13946 | FL |
Y | 213EG0000X | General Practice | DN13946 | FL |
NPI | 1245258565 |
---|---|
Provider Name | Dr. Luis Angel Estrada |
First Address | Winter Garden, FL 34787-3546 |
Second Address | Groveland, FL 34736-2012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 20/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0757934-00 | (05) | FL |