Provider Demographics
NPI:1386965911
Name:PRESTOSA, AIDA FAGELA (RPH)
Entity type:Individual
Prefix:MRS
First Name:AIDA
Middle Name:FAGELA
Last Name:PRESTOSA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9715 OTIS ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-4931
Mailing Address - Country:US
Mailing Address - Phone:323-566-1198
Mailing Address - Fax:323-566-0760
Practice Address - Street 1:9715 OTIS ST
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-4931
Practice Address - Country:US
Practice Address - Phone:323-566-1198
Practice Address - Fax:323-566-0760
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist