Provider Demographics
NPI:1104051499
Name:LOPEZ PASTRANA, JAHAIRA (MD)
Entity type:Individual
Prefix:
First Name:JAHAIRA
Middle Name:
Last Name:LOPEZ PASTRANA
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 1:25 TAMARACK CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1750
Mailing Address - Country:US
Mailing Address - Phone:787-239-3955
Mailing Address - Fax:
Practice Address - Street 1:25 TAMARACK CIR
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-1750
Practice Address - Country:US
Practice Address - Phone:787-239-3955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4682412084P0015X
PR175622084P0800X
PAMD4682412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine