Provider Demographics
NPI:1063002806
Name:DIEGO PASTRANA, ELIZABETH (LPN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DIEGO PASTRANA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 GAYLORD ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1207
Mailing Address - Country:US
Mailing Address - Phone:303-388-5894
Mailing Address - Fax:
Practice Address - Street 1:1620 GAYLORD ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1207
Practice Address - Country:US
Practice Address - Phone:303-388-5894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0334399164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1620OtherN/A