Healthcare Provider Details

I. General information

NPI: 1295721884
Provider Name (Legal Business Name): JOHN T BESTOSO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR UCSD MEDICAL CENTER, SUITE 8781
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

5680 DOROTHY WAY
SAN DIEGO CA
92115-2307
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-7310
  • Fax: 619-543-7368
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG87345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: