Provider Demographics
NPI:1437250180
Name:PESTANA AND PESTANA, MD, PA
Entity Type:Organization
Organization Name:PESTANA AND PESTANA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVO
Authorized Official - Middle Name:D
Authorized Official - Last Name:PESTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-755-8844
Mailing Address - Street 1:PO BOX 8025
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33075-8025
Mailing Address - Country:US
Mailing Address - Phone:954-755-8844
Mailing Address - Fax:954-755-0272
Practice Address - Street 1:3100 CORAL HILLS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4137
Practice Address - Country:US
Practice Address - Phone:954-755-8844
Practice Address - Fax:954-755-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91351207R00000X
FLME34450208000000X
FLME33915208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty