Provider Demographics
NPI:1053794735
Name:C RICARDO ESTRADA DO PA
Entity type:Organization
Organization Name:C RICARDO ESTRADA DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:RICARDO
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:956-568-2592
Mailing Address - Street 1:PO BOX 451470
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0036
Mailing Address - Country:US
Mailing Address - Phone:956-568-2592
Mailing Address - Fax:956-568-2631
Practice Address - Street 1:1710 E SAUNDERS ST STE B270
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5448
Practice Address - Country:US
Practice Address - Phone:956-568-2592
Practice Address - Fax:956-568-2631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1427207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00452TOtherMEDICARE PTAN
TX101705504Medicaid
TX101705504Medicaid