Provider Demographics
NPI:1063239721
Name:PASTRANA, LYDIA
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:PASTRANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SUMMIT AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:ANTRIM
Mailing Address - State:NH
Mailing Address - Zip Code:03440-3613
Mailing Address - Country:US
Mailing Address - Phone:616-856-6122
Mailing Address - Fax:
Practice Address - Street 1:11 BOBCAT BLVD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NH
Practice Address - Zip Code:03244-7419
Practice Address - Country:US
Practice Address - Phone:603-478-5236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program