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NPI Code Detail

MEDICARE: DR. ELSA PESTANA MD

MEDICARE: DR. ELSA PESTANA MD
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
1208000000XPediatrics PhysicianME34450FL

General Provider Information

NPI Number : 1295721769
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELSA PESTANA MD
Provider Business Mailing Address
First Line : 9960 NW 45TH ST
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33065-1545
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3000 CORAL HILLS DR
Second Line : CORAL SPRINGS PEDIATRICS DEPT.
City : CORAL SPRINGS
State : FL
Zip : 33065-4108
Country : US
Telephone Number : 954-344-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2005
Last Update Date : 07/08/2007

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