Provider Demographics
NPI:1356587992
Name:ESTRADA, ERIC (RDN, LD)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 N WARE RD # 7
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6616
Mailing Address - Country:US
Mailing Address - Phone:956-213-8686
Mailing Address - Fax:956-688-8340
Practice Address - Street 1:709 N WARE RD STE 7
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6623
Practice Address - Country:US
Practice Address - Phone:956-213-8686
Practice Address - Fax:956-688-8340
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-04
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX980744133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20047772-01Medicaid