MEDICARE: DR. LENA PASTERNAK DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	TL.0006407	CO
2	390200000X	Student in an Organized Health Care Education/Training Program	TL.0006407	CO
3	207R00000X	Internal Medicine Physician	DR.0062434	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	029299	OTHER	CO	KAISER COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1811438393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LENA PASTERNAK DO

Provider Business Mailing Address
First Line	:	10350 E DAKOTA AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80247-1314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 W PUEBLO BLVD
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81004-3816
Country	:	US
Telephone Number	:	303-338-4545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2017
Last Update Date	:	10/07/2021

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Directions to “ DR. LENA PASTERNAK DO” Practice Location

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