Provider Demographics
NPI:1235432493
Name:EDWARD H BESTARD M D INC
Entity Type:Organization
Organization Name:EDWARD H BESTARD M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-661-8817
Mailing Address - Street 1:653 CAMINO DE LOS MARES
Mailing Address - Street 2:102
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2808
Mailing Address - Country:US
Mailing Address - Phone:949-661-8817
Mailing Address - Fax:949-661-9033
Practice Address - Street 1:653 CAMINO DE LOS MARES
Practice Address - Street 2:102
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2808
Practice Address - Country:US
Practice Address - Phone:949-661-8817
Practice Address - Fax:949-661-9033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50298261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1396857769OtherINDIVIDUAL NPI
1396857769OtherINDIVIDUAL NPI
G50298Medicare PIN