Provider Demographics
NPI:1043461320
Name:PESANTE PINTO, JOSE A
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:PESANTE PINTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 CALLE ARNEDO
Mailing Address - Street 2:URB. VALENCIA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-1845
Mailing Address - Country:US
Mailing Address - Phone:787-367-8681
Mailing Address - Fax:787-767-1920
Practice Address - Street 1:518 CALLE ARNEDO
Practice Address - Street 2:URB. VALENCIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-1845
Practice Address - Country:US
Practice Address - Phone:787-367-8681
Practice Address - Fax:787-767-1920
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 913416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0059220Medicare PIN