MEDICARE: CARLOS PESTANA M.D.

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	208600000X	Surgery Physician	D5150	TX

General Provider Information

NPI Number	:	1457629883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS PESTANA M.D.

Provider Business Mailing Address
First Line	:	10123 N MANTON LN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1932
Country	:	US
Telephone Number	:	210-344-6506
Fax Number	:

Provider Business Practice Location Address
First Line	:	10123 N MANTON LN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1932
Country	:	US
Telephone Number	:	210-344-6506
Fax Number	:

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

Provider Enumeration Date	:	12/13/2011
Last Update Date	:	12/13/2011

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Directions to “ CARLOS PESTANA M.D.” Practice Location

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