Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | G2361 | TX |
N | 208000000X | Pediatrician | G2361 | TX |
Y | 2080P0207X | Pediatric Hematology-Oncologist | G2361 | TX |
NPI | 1396792065 |
---|---|
Provider Name | Jaime Estrada |
First Address | San Antonio, TX 78229-3311 |
Second Address | San Antonio, TX 78229-3755 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 04/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
133046612 | (05) | TX |
133046613 | CSHCN (01) | TX |
8BX389 | BCBS (01) | TX |