Provider Demographics
NPI:1124307814
Name:PASTRANA MAISONET, GUILLERMO J (MD)
Entity type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:J
Last Name:PASTRANA MAISONET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8578
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-0578
Mailing Address - Country:US
Mailing Address - Phone:787-488-0292
Mailing Address - Fax:939-355-0129
Practice Address - Street 1:505 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3201
Practice Address - Country:US
Practice Address - Phone:787-902-6631
Practice Address - Fax:787-339-2700
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR18300208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR18300OtherPR MEDICAL LICENSE NUMBER