Provider Demographics
NPI:1316068612
Name:PESTANA, ROCIO (MD)
Entity type:Individual
Prefix:DR
First Name:ROCIO
Middle Name:
Last Name:PESTANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5995 SW 71ST ST STE 403
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3531
Mailing Address - Country:US
Mailing Address - Phone:305-665-6926
Mailing Address - Fax:305-665-4670
Practice Address - Street 1:5995 SW 71ST ST STE 403
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:305-665-6926
Practice Address - Fax:305-665-4670
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76179207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME76179OtherFLORIDA MEDICAL LICENSE
FLG11013Medicare UPIN
FLE1129ZMedicare ID - Type Unspecified