Provider Demographics
NPI:1851473862
Name:PILEST, NISSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NISSAN
Middle Name:
Last Name:PILEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16100 SAND CANYON AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3723
Mailing Address - Country:US
Mailing Address - Phone:949-727-3800
Mailing Address - Fax:949-727-3888
Practice Address - Street 1:16100 SAND CANYON AVE STE 190
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3723
Practice Address - Country:US
Practice Address - Phone:949-727-3800
Practice Address - Fax:949-727-3888
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30988207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA756071348OtherRAILROAD MEDICARE
WA30988AMedicare PIN