Provider Demographics
NPI:1275724726
Name:PASTORA, LEONEL A
Entity Type:Individual
Prefix:MR
First Name:LEONEL
Middle Name:A
Last Name:PASTORA
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 1:4845 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541
Mailing Address - Country:US
Mailing Address - Phone:813-783-8442
Mailing Address - Fax:813-783-8442
Practice Address - Street 1:4845 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541
Practice Address - Country:US
Practice Address - Phone:813-783-8442
Practice Address - Fax:813-783-8442
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0654240001Medicare NSC
FL065424000Medicare PIN