Provider Demographics
NPI:1487603254
Name:PESTANA, DAMIAN R (MD)
Entity type:Individual
Prefix:
First Name:DAMIAN
Middle Name:R
Last Name:PESTANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 PEARSON RD
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5045
Mailing Address - Country:US
Mailing Address - Phone:530-877-0400
Mailing Address - Fax:530-877-0407
Practice Address - Street 1:153 PEARSON RD
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5045
Practice Address - Country:US
Practice Address - Phone:530-877-0400
Practice Address - Fax:530-877-0407
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27221207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DS815AMedicare PIN