Provider Demographics
NPI:1710733233
Name:PESTANA OLIVO, MARIA FERNANDA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:FERNANDA
Last Name:PESTANA OLIVO
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 1:234 E 149TH ST RM 4-20
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5504
Mailing Address - Country:US
Mailing Address - Phone:718-579-5030
Mailing Address - Fax:718-579-4700
Practice Address - Street 1:234 E 149TH ST RM 4-20
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5030
Practice Address - Fax:718-579-4700
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program