Active NPI
Antonio Estrada Mashburn
- Student in an Organized Health Care Education/Training Program
- Jefferson, LA
National Provider Identifier
1124870068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 1514 Jefferson Hwy
Jefferson, LA 70121-2429 - Phone
- (504) 842-3000
- NPI assigned
- Apr 3, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
1514 Jefferson Hwy
Jefferson, LA 70121-2429
Mailing address
800 Ebb Tide Dr
Pensacola, FL 32507-7945
Phone (850) 637-5777
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240628000573 | LA | Order and Referring Only - Internal Medicine | 6305380577 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718841600000",
"number": "1124870068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 EBB TIDE DR",
"city": "PENSACOLA",
"state": "FL",
"postal_code": "325077945",
"telephone_number": "850-637-5777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1514 JEFFERSON HWY",
"city": "JEFFERSON",
"state": "LA",
"postal_code": "701212429",
"telephone_number": "504-842-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ESTRADA MASHBURN",
"first_name": "ANTONIO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-03",
"last_updated": "2024-06-20",
"certification_date": "2024-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jefferson, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.