Provider Demographics
NPI:1104878693
Name:PASTRANA, PABLO (MD)
Entity type:Individual
Prefix:DR
First Name:PABLO
Middle Name:
Last Name:PASTRANA
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:PO BOX 1283
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-1283
Mailing Address - Country:US
Mailing Address - Phone:787-732-5970
Mailing Address - Fax:
Practice Address - Street 1:33 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703-3215
Practice Address - Country:US
Practice Address - Phone:787-732-5970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9475174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF18908Medicare UPIN