Provider Demographics
NPI:1801587696
Name:DE VERA, CAROLINE ESTRADA (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:ESTRADA
Last Name:DE VERA
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 W BRECKENRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1725
Mailing Address - Country:US
Mailing Address - Phone:323-867-1474
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST STE 8C
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-1302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program