MEDICARE: GENOR 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	106S00000X	Behavior Technician	RBT24382897	FL

General Provider Information

NPI Number	:	1316757842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENOR PESTANA

Provider Business Mailing Address
First Line	:	3031 NW 166TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6447
Country	:	US
Telephone Number	:	713-517-0309
Fax Number	:

Provider Business Practice Location Address
First Line	:	11300 NW 87TH CT STE 149
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4520
Country	:	US
Telephone Number	:	786-518-3452
Fax Number	:	786-518-3453

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

Provider Enumeration Date	:	01/08/2025
Last Update Date	:	01/08/2025

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Directions to “ GENOR PESTANA ” Practice Location

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