Provider Demographics
NPI:1396752176
Name:PASTOR, CRAIG (DPM)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:PASTOR
Suffix:
Gender:M
Credentials:DPM
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 1682
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90707-1682
Mailing Address - Country:US
Mailing Address - Phone:562-229-9452
Mailing Address - Fax:562-920-4642
Practice Address - Street 1:10234 ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-2602
Practice Address - Country:US
Practice Address - Phone:562-920-1632
Practice Address - Fax:562-920-4643
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3641213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00E36410OtherBLUE SHIELD
CA00E36410Medicaid
CAU26014Medicare UPIN
CAWE3641DMedicare ID - Type Unspecified