MEDICARE: JAKE PESTANA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1205580149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAKE PESTANA

Provider Business Mailing Address
First Line	:	607 PLEASANT ST
Second Line	:
City	:	ATTLEBORO
State	:	MA
Zip	:	02703-2570
Country	:	US
Telephone Number	:	508-324-0328
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 MYLES STANDISH BLVD
Second Line	:
City	:	TAUNTON
State	:	MA
Zip	:	02780-7387
Country	:	US
Telephone Number	:	508-824-1355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2022
Last Update Date	:	05/04/2026

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Directions to “ JAKE PESTANA ” Practice Location

Language	Start Address	Practice Location

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