Provider Demographics
NPI:1942258645
Name:PESTANA, IVO D (MD)
Entity Type:Individual
Prefix:
First Name:IVO
Middle Name:D
Last Name:PESTANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3100 CORAL HILLS DR
Mailing Address - Street 2:NO 201
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4137
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:NO 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME339152086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGI432ZOtherMEDICARE
FL039840300Medicaid
FL039840300Medicaid