Healthcare Provider Details

I. General information

NPI: 1003652264
Provider Name (Legal Business Name): LUIS FERNANDO PASTEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2024
Last Update Date: 07/06/2024
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOULEVARD DE LAS BELLAS ARTES 19315, NUEVA TIJUANA BOULEVAD DE LAS BELLAS ARTES 19315, NUEVA TIJUANA
TIJUANA MEXICO
22435
MX

IV. Provider business mailing address

1752 FERNWOOD RD
CHULA VISTA CA
91913-1563
US

V. Phone/Fax

Practice location:
  • Phone: 664-873-2811
  • Fax:
Mailing address:
  • Phone: 619-493-9457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number09181235
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: