Healthcare Provider Details

I. General information

NPI: 1013237205
Provider Name (Legal Business Name): DAVID TIONGCO PRESTOSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 N 11TH ST. IM INTERNAL MEDICINE
RICHMOND VA
23298
US

IV. Provider business mailing address

PO BOX 980509 IM INTERNAL MEDICINE
RICHMOND VA
23298
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-8786
  • Fax:
Mailing address:
  • Phone: 804-828-9726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116022441
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: