Healthcare Provider Details

I. General information

NPI: 1578629820
Provider Name (Legal Business Name): CHERYL ANN PRESTIANNI N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 LEWIS ST STE 100
SAN DIEGO CA
92103-2108
US

IV. Provider business mailing address

330 LEWIS ST STE 100
SAN DIEGO CA
92103-2108
US

V. Phone/Fax

Practice location:
  • Phone: 619-471-9210
  • Fax: 619-471-9211
Mailing address:
  • Phone: 619-471-9210
  • Fax: 619-471-9211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number234064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: