Provider Demographics
NPI:1346224557
Name:PRESTERA, TORY (MDPHD)
Entity Type:Individual
Prefix:
First Name:TORY
Middle Name:
Last Name:PRESTERA
Suffix:
Gender:M
Credentials:MDPHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N RANCHO SANTA FE RD STE 126
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-1294
Mailing Address - Country:US
Mailing Address - Phone:760-598-0400
Mailing Address - Fax:760-598-5270
Practice Address - Street 1:100 N RANCHO SANTA FE RD
Practice Address - Street 2:SUITE 126
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-1294
Practice Address - Country:US
Practice Address - Phone:760-598-0400
Practice Address - Fax:760-290-7044
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62321207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA62321Medicare ID - Type Unspecified
CAG85705Medicare UPIN