Basic Information
| Provider Information | |||||||||
| NPI: | 1790775088 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESTRADA | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | SORIANO | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MPAS, PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 VIEW HALLO WAY | ||||||||
| Address2: | |||||||||
| City: | YORKTOWN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236933365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578675035 | ||||||||
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| Practice Location | |||||||||
| Address1: | 576 JEFFERSON AVE | ||||||||
| Address2: | US ARMY MEDICAL DEPARTMENT ACTIVITY | ||||||||
| City: | FORT EUSTIS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236041602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573147887 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1041741 | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.