Healthcare Provider Details

I. General information

NPI: 1104878693
Provider Name (Legal Business Name): PABLO PASTRANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 CALLE MUNOZ RIVERA
AGUAS BUENAS PR
00703-3215
US

IV. Provider business mailing address

PO BOX 1283
AGUAS BUENAS PR
00703-1283
US

V. Phone/Fax

Practice location:
  • Phone: 787-732-5970
  • Fax:
Mailing address:
  • Phone: 787-732-5970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number9475
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: