Provider Demographics
NPI:1467633222
Name:DR. PABLO A. PASTRANA MALDONADO CSP
Entity Type:Organization
Organization Name:DR. PABLO A. PASTRANA MALDONADO CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:PASTRANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-732-5970
Mailing Address - Street 1:33 CALLE MUNOZ RIVERA
Mailing Address - Street 2:PO BOX 1283
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-3215
Mailing Address - Country:US
Mailing Address - Phone:787-732-5970
Mailing Address - Fax:
Practice Address - Street 1:33 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703-3215
Practice Address - Country:US
Practice Address - Phone:787-732-5970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF18908Medicare UPIN