1114450475 NPI number — FRANCISCO J PESTANA, DMD

Table of content: (NPI 1114450475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114450475 NPI number — FRANCISCO J PESTANA, DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRANCISCO J PESTANA, DMD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114450475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3429 BROADWAY ST
Provider Second Line Business Mailing Address:
SUITE C1-C2
Provider Business Mailing Address City Name:
AMERICAN CANYON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94503-1230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-980-7274
Provider Business Mailing Address Fax Number:
707-731-1885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3429 BROADWAY ST
Provider Second Line Business Practice Location Address:
SUITE C1-C2
Provider Business Practice Location Address City Name:
AMERICAN CANYON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94503-1230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-980-7274
Provider Business Practice Location Address Fax Number:
707-731-1885
Provider Enumeration Date:
04/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
PESTANA
Authorized Official First Name:
FRANCISCO
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
530-300-1407

Provider Taxonomy Codes

  • Taxonomy code: 261QS0112X , with the licence number:  47153 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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