Provider Demographics
NPI:1689433005
Name:PRESTENBURG, ERIC WILLIAM
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:WILLIAM
Last Name:PRESTENBURG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 PERDIDO ST STE 8226
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1352
Mailing Address - Country:US
Mailing Address - Phone:504-568-2319
Mailing Address - Fax:504-568-2317
Practice Address - Street 1:2021 PERDIDO ST STE 8226
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1352
Practice Address - Country:US
Practice Address - Phone:504-568-2319
Practice Address - Fax:504-568-2317
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program