Provider Demographics
NPI:1033446711
Name:PASTRAN, MARIBEL (RD, CD)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:PASTRAN
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:MARIBEL
Other - Middle Name:
Other - Last Name:HIDALGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, CD
Mailing Address - Street 1:6284 LANCASTER PL
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-9167
Mailing Address - Country:US
Mailing Address - Phone:269-815-2503
Mailing Address - Fax:
Practice Address - Street 1:720 ESKENAZI AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5187
Practice Address - Country:US
Practice Address - Phone:317-880-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1265133N00000X
MD819840133V00000X
IN37002599A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist