Provider Demographics
NPI:1831788306
Name:SANTOS PESTANA, MAYELIN
Entity type:Individual
Prefix:
First Name:MAYELIN
Middle Name:
Last Name:SANTOS PESTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19325 SW 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-6514
Mailing Address - Country:US
Mailing Address - Phone:305-720-3733
Mailing Address - Fax:
Practice Address - Street 1:19325 SW 120TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-6514
Practice Address - Country:US
Practice Address - Phone:305-720-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9552221163W00000X
FL11025783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse