Provider Demographics
NPI:1376505628
Name:PESTANA, TATIANA ANGELICA (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:ANGELICA
Last Name:PESTANA
Suffix:
Gender:F
Credentials:MD, MPH
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Mailing Address - Street 1:3100 CORAL HILLS DR
Mailing Address - Street 2:SUITE 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:SUITE 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?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME91351207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271405100Medicaid