Provider Demographics
NPI:1528210622
Name:PESTANAS, NOEL P (RN)
Entity Type:Individual
Prefix:MR
First Name:NOEL
Middle Name:P
Last Name:PESTANAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 SOUTH CALIFORNIA AV
Mailing Address - Street 2:UNIT E
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016
Mailing Address - Country:US
Mailing Address - Phone:626-536-8421
Mailing Address - Fax:
Practice Address - Street 1:815 S CALIFORNIA AVE APT E
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3664
Practice Address - Country:US
Practice Address - Phone:626-536-8421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN477122163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse