Provider Demographics
NPI:1619432333
Name:PESTANA, KRISTINA (CNS, LDN)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:PESTANA
Suffix:
Gender:F
Credentials:CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 N TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-4789
Mailing Address - Country:US
Mailing Address - Phone:786-205-4044
Mailing Address - Fax:
Practice Address - Street 1:412 ELDEN ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4511
Practice Address - Country:US
Practice Address - Phone:703-657-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4628133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDX4628OtherSTATE BOARD OF DIETETIC PRACTICE