Provider Demographics
NPI:1831584044
Name:PRESTOZA, MICHELLE OBILLO (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:OBILLO
Last Name:PRESTOZA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:13640 N PLAZA DEL RIO BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13640 N PLAZA DEL RIO BLVD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4846
Practice Address - Country:US
Practice Address - Phone:623-876-3830
Practice Address - Fax:623-285-2608
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ55931207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine