Provider Demographics
NPI:1003097189
Name:PASCUAL, GERARDO O (MD)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:O
Last Name:PASCUAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 BOYER LN
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-6131
Mailing Address - Country:US
Mailing Address - Phone:626-964-7174
Mailing Address - Fax:626-839-1578
Practice Address - Street 1:626 BOYER LN
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-6131
Practice Address - Country:US
Practice Address - Phone:626-964-7174
Practice Address - Fax:626-839-1578
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-17
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35566261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care