Provider Demographics
NPI:1033704556
Name:PASTRANA, MELVIN OMAR
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:OMAR
Last Name:PASTRANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PARCELAS NUEVAS DE TERRANOVA
Mailing Address - Street 2:CALLE 10 CASA # 166
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678
Mailing Address - Country:US
Mailing Address - Phone:787-240-9428
Mailing Address - Fax:
Practice Address - Street 1:PARCELAS NUEVAS DE TERRANOVA
Practice Address - Street 2:CALLE 10 CASA # 166
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-240-9428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8623183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRR00069047Other8623