Healthcare Provider Details

I. General information

NPI: 1215875513
Provider Name (Legal Business Name): MK LOTUS MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 FLORES ROSA LOOP
BARRIGADA GU
96913-1247
US

IV. Provider business mailing address

182 FLORES ROSA LOOP
BARRIGADA GU
96913-1247
US

V. Phone/Fax

Practice location:
  • Phone: 323-904-2408
  • Fax:
Mailing address:
  • Phone: 323-904-2408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: KRISTINE MAE PASCO
Title or Position: OWNER
Credential: DNP
Phone: 323-904-2408