Provider Demographics
NPI:1396857769
Name:BESTARD, EDWARD HORACIO (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:HORACIO
Last Name:BESTARD
Suffix:
Gender:M
Credentials:MD, FACS
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Mailing Address - Street 1:653 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2808
Mailing Address - Country:US
Mailing Address - Phone:949-661-8800
Mailing Address - Fax:949-661-9033
Practice Address - Street 1:653 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2808
Practice Address - Country:US
Practice Address - Phone:949-661-8800
Practice Address - Fax:949-661-9033
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG50298207X00000X, 207XS0106X, 207XX0004X, 207XX0005X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G5029800Medicaid
CA00G5029800Medicaid
CAG502980Medicare ID - Type Unspecified